Medicaid value based programs have yet prove themselves

The Many individual insurers have been after Medicare’s lead. Much of the policy attention was on apps like accountable maintenance businesses and bundled obligations; nonetheless, value-based purchasing or Pay for Performance, understood to be providers getting paid back with repayment adjustments up or down based on value metrics, and remains a central section of value … Read more

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Use of antidepressants on rise

Women age 65 and older are the biggest users of antidepressants, but use is up across all categories, according to a report by Medco called America’s State of Mind. The PBM reviewed prescription drug claims for more than 2 million people to gauge the use of mental health medications between 2001 and 2010. Men, women, … Read more

FDA Approves Hemophilia B Therapy Idelvion

Patients can go up to two weeks between infusions The FDA has given the nod to Idelvion (coagulation factor IX [recombinant], albumin fusion protein, CSL Behring), a long-acting albumin fusion protein linking recombinant coagulation factor IX with recombinant albumin for the treatment of patients with hemophilia B. Idelvion is the first factor IX therapy that … Read more

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Roche buy spark therapeutics 48-billion

The Swiss medication and diagnostics giant Roche has decided to buy the gene therapy company Spark Therapeutics for $4.8 billion, significantly more than twice Spark’s stock exchange value of roughly $2 billion until the sale was announced. The top price indicates Roche’s decision to combine with the growing gene therapy field, also if profits from … Read more

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‘The Badger State’ pays FPs and GPs the most

Family and general practitioners would do well to move their practices to Wisconsin, Arkansas, West Virginia, or Kansas. That’s because FPs and GPs in these five states get paid the most for this profession — especially when the cost of living is factored in. Cost of living applies to the average cost of basic necessities … Read more

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Ethics of Alternative Medicine: The Unconventional Has Its Place

By John La Puma, M.D. Two years ago, ethical issues in alternative medicine seemed hard to recognize. Alternative medicine was just starting to make medical headlines — the first academic centers and fellowships began, elective medical school classes surfaced, outpatient pharmacies stocked up on zinc and echinacea. So two years ago, I used Jonsen, Siegler … Read more

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A Conversation with John Driscoll, CEO, CareCentrix

Post-Acute Care Vendors Allow Plans To Focus on Hospital, Medical Costs Interview by Peter Wehrwein Tweet Widget(link is external) Shortening lengths of stay in nursing homes and hospitals, cutting back on readmissions, delivering safe, effective care at home—his company can make these things happen, says John Driscoll, 56, who has been the CEO of CareCentrix … Read more

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Demand for primary care physicians slackens while outlook for specialists seems to brighten

Color charts Also available in PDF The demand for primary care physicians is lessening relative to the demand for specialists, according to information gathered by Merritt, Hawkins & Associates, a health care headhunting company. In 1996—97, Merritt experienced a 12-percent increase in searches for primary care physicians compared with the previous year, but for the … Read more

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Kaiser’s EMR Push Pays Off

It has not been easy to launch the massive HealthConnect system, but officials at the health plan say it has been rewarding Talk to Louise Lang, MD, the executive vice president for clinical systems and quality at Kaiser Permanente, about how the health plan managed to install what it calls the biggest electronic medical record … Read more

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Merck’s biosimilar debuts 35 list price discount remicade

The Food and Medication Organization and the Government Exchange Commission have a long history of working cooperatively to secure American buyers. We have officially worked together since 1954 to help the significant missions of both FDA and FTC. Quite a bit of our cooperative work centers around guaranteeing that publicizing and other limited time interchanges … Read more

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Primary care gains over 3 years

Primary care physicians enjoyed a 4 percent increase in compensation in 2006, less than the aggregate of medical and surgical specialties, which had a 6 percent increase, according to the American Medical Group Association. But if you look at the graph below, you’ll see that over the three years ending in 2006, primary care specialties … Read more

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The Weight Debate

Encouraged by employers, health plans ponder expensive options in covering a generation of obese Americans The news on weight in America is almost all bad. Pick up any popular consumer magazine, flip on any morning news show, or surf health-related Web pages, and chances are you’ll find at least a few reports sounding the alarm … Read more

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An Evidence-Based Evaluation of Percutaneous Vertebroplasty

Costs are relatively low for this minimally invasive procedure, compared with open surgical interventions for vertebral compression fractures, such as internal fixation and spinal fusion. Susan A. Levine, D.V.M., Ph.D. Hayes Inc. Lawrence A. Perin, M.D., M.B.A. Chief of Medical Staff, Aviano Air Force Base, Italy Diane Hayes, Ph.D. Hayes Inc. and School of Medicine … Read more

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SWITCHING DOCTORS, SWITCHING PLANS: The ‘Revolving Door’ Problem

Last August, when his employer was acquired by another company, a 49-year-old man with a history of Type I diabetes, early renal disease, diabetic retinopathy and chronic asthma became a patient turnover statistic. He was forced to change his health insurance from a fee-for-service plan with Blue Cross/Blue Shield to an Aetna preferred-provider organization. As … Read more

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Today’s technology can facilitate collaborative network management

Based on a satellite symposium at SLEEP 2006 — the 20th anniversary meeting of the Associated Professional Sleep Societies, this supplement reviews past and present sleep management practices and identifies and addresses barriers to suitable care. The authors examines the impact of sleep disorders on patients, providers, and employers. Highlights: The Economic Burden of Chronic … Read more

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Pa. Pharmacies Sue for Better Medicaid Money

ndependent pharmacies in the Philadelphia area say they are being driven out of business by low reimbursements for Medicaid prescriptions, and have sued to force higher payments. All Medicaid patients in the Philadelphia area are in HealthChoices, a state-administered managed care organization that contracts with four HMOs to provide services. In suits filed in state … Read more

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Blues Build on CMS Program To Boost Hospital Quality

Insurer throws support behind P4P program that promises “stunning” advances in cost-effectiveness Lola Butcher MANAGED CARE November 2007. ©MediMedia USA Insurer throws support behind P4P program that promises “stunning” advances in cost-effectiveness Lola Butcher Impressed with the results of a major hospital pay-for-performance program, the Blue Cross & Blue Shield Association is putting its strength behind a … Read more

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Research shows transition from volume to value

This paper discusses how Volume-Price supply of stock industry. The standard Distribution-like structures constituting different period have been studied, depending on what we propose a predictive version of Volume-Price supply in China stock exchange. The newspaper comprises three parts: First, the hypothesis that the Chinese stock exchange stock investing volume-price distributions will not comply with … Read more

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CMS hybrid payment system shows promise

Combining Medicare fee-for-service payments with new incentive programs could help physician groups save money for Medicare and reach quality-of-care targets, according to the February 2008 Medicare Physician Payment report issued by the Government Accountability Office. The Centers for Medicare & Medicaid Services undertook a pilot program involving 10 physician group practices with more than 200 … Read more

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2003

January 2003 February 2003 March 2003 April 2003 May 2003 June 2003 July 2003 August 2003 September 2003 October 2003 November 2003 December 2003 Paul LendnerPaul Lendner ist ein praktizierender Experte im Bereich Gesundheit, Medizin und Fitness. Er schreibt bereits seit über 5 Jahren für das Managed Care Mag. Mit seinen Artikeln, die einen einzigartigen … Read more

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First discovery us colistin resistance human e-coli infection

Colistin is your final broker utilized to fight germs which are resistant Into the most powerful antibiotics. Colistin has stayed the ideal tool offered to take care of multidrug resistant germs since bacteria weren’t measuring genes because of its immunity. This newest discovery demonstrates that colistin could be losing its efficacy in anti inflammatory therapy. … Read more

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Vaccination: Is 1 oz. of Prevention Still Worth 1 lb. of Cure?

Immunizations are a good deal for public health, but their growing number and rising costs pose a challenge for plans that must pay doctors for administering them It’s not the kind of truism you stitch in needlepoint and hang on the wall, but in health care almost every opportunity is also a problem. And the … Read more

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What the Primary Care Physician Shortage Means for Health Plans

Insurers fear rising costs and poorer outcomes if members are less able to get appointments with family physicians and general internists MargaretAnn Cross Contributing Editor Talking with junior and senior medical students during symposiums at the University of Minnesota, George Isham, MD, chief health officer and plan medical director at HealthPartners, shares his experiences and … Read more

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DC maryland blues plans come together

Independence Blue Cross teams up with the American College of Physicians to create an online program that facilitates creation of medical homes In the excitement over the focus on the patient-centered medical home (PCMH), some physicians murmured a question that might not have been heard: Exactly how does one build a PCMH? Michael S. Barr, … Read more

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Insurance Connector Key To Newly Proposed Health Plan

The Commonwealth Fund has advanced a plan that it says would insure 44 million of the estimated 48 million uninsured Americans and would offer new health insurance choices to individuals and small businesses for 30 percent less than what employers pay now. Dubbed the “Building Blocks” plan by the Commonwealth Fund, it would preserve employer-sponsored … Read more

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Aetna’s profits soar second quarter

CVS Health’s profits jumped over 50 Percent as Optional procedures the Organization giant’s Aetna health plan pays were delayed amid the spread of their Coronavirus breed Covid-19. CVS Health Leader officer Larry Merlo stated the Organization’s Diversified company portfolio which features drugstores, retail practices in addition to medication and health benefits will be helping the … Read more

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What Can Be Done to Counteract Growing Power of Providers?

Three health plans outline steps they are taking to deal with the effects of growing consolidation of providers For Georganne Chapin, a report that hospitals and physicians were wielding increased market power in several cities was not news. The president and CEO of the not-for-profit Hudson Health Plan in Tarrytown, N.Y., was well aware of … Read more

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Boom Times for Brain Injuries

Americans are going to emergency departments for traumatic brain injuries in record numbers. What’s behind the increase? What are obstacles to care? The CDC, the World Health Organization, and a string of prominent U.S. medical organizations have repeatedly and unequivocally declared traumatic brain injury (TBI) a major public health problem. Yet that’s where certainty about … Read more

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Patients Slammed With Huge Ambulance Costs Because Insurers, Ambulance Companies Can’t Negotiate Contracts

Many patients with private insurance who are taken to the hospital by ambulance also feel that they are being taken to the cleaners. An investigation by Kaiser Health News (KHN) finds patients are stuck with exorbitant out-of-network bills because the ambulance companies and insurers had not hammered out a contract. The ambulance companies say that … Read more

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Insurers relax rules help members after hurricanes harvey irma

Discrimination persists in many areas, but slow progress is being made Perhaps never before have so many organizations done so much in such a short time to improve health care for the lesbian, gay, bisexual, and transgender (LGBT) community. While significant strides have been made, much more must be done, say advocates for that community. … Read more

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Decline of the Small Practice Might Make Plans’ Job Easier

John Marcille Change is difficult for many people. They fear it, and sometimes with good reason. The changes we observe in the organization of the physician workforce — changes that our cover story, starting on Page 14, is about — are certainly disconcerting to some physicians. Simply put, the long erosion of small practice is … Read more

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Terror’s Effect on Technology Adoption

SYSTEMS & SOFTWARE Joyce Ochs As a former health care planner, I have always kept this motto near my desk: “Life is what happens to you while you’re busy making other plans.” These words seem appropriate to our world today as never before. In this column, we usually look at the different ways nonmedical technology … Read more

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Drug interactions plague elderly cancer patients

Adverse drug reaction increases six-fold from the second decade to the eighth decade of life, from 10 adverse events per 10,000 persons to 60 per 10,000. This is especially important to oncology patients. J.F. Knudsen, PhD, MD, a research associate at New Hope Cancer Center in Hudson, Fla., and other researchers performed a retrospective cohort … Read more

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February 1996

How Surveys Answer a Key Question: Are Consumers Satisfied With Managed Care? Some opinion surveys seem to demonstrate wide public acceptance of managed care, while others find widespread complaints. A survey professional explains how results can depend on methods — and what we know for sure. Why It Pays To Go ‘Online’ Is it worthwhile … Read more

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Payers Benefit When Hospitals Issue Improved Discharge Orders

High quality post-hospital orders can cut readmissions by 30 percent. Medical administrators may soon insist on it. Tony Berberabe Patients who have a clear understanding of their after-hospital care instructions, including how to take their medications and when to make follow-up appointments, are 30 percent less likely to be readmitted or to revisit the emergency … Read more

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Kaiser, Aetna Keep Eyes On Health Care Consumer

By John A. Marcille Sometimes breaking old ground can be just as satisfying as breaking new. Take our cover story. The article looks at how the corporate cultures at Aetna U.S. Healthcare and Kaiser Permanente shaped their reactions to recent financial setbacks and positioned them for the future. What these two plans are looking at, experts believe, … Read more

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First non controlled substance treatment narcolepsy

Privately Held Harmony Bio-sciences just Borrows Consent by the U.S. Food and Drug Administration Because of its Very First Business Solution, a Remedy for narcolepsy. Maybe not just will be it Wakix the earliest business product to Harmony bio-sciences, however, it is, in addition, the very first remedy method for narcolepsy accepted from the FDA … Read more

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AMCP Seeks an End to 20 Years of Confusion Over FDAMA Section 114

The law was supposed to give drugmakers freedom to share health care economic information about their products. Efforts to get clarity from the FDA are stepping up. Value-based purchasing in health care has reached the point of no return, no matter who wins the White House or if the ACA were to get scrapped. The … Read more

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FDA Panel Likes New Treatment for Idiopathic Pulmonary Fibrosis

A fatal disease with many victims, IPF has been shown to progress more slowly when treated by pirfenidone. The FDA itself has not yet ruled on it.   Idiopathic pulmonary fibrosis (IPF), the most common form of interstitial lung disease, is a crippling and ultimately fatal disease diagnosed in about 30,000 Americans each year — … Read more

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May 1999

Employers Starting To Hold HMOs Accountable for Quality Cost is still the overriding concern, but some cutting-edge companies have been asking HMOs to meet specific administrative and clinical goals. Should Uncle Sam Insure Us All? It’s an idea that just won’t die: Having government pay the medical bills guarantees universal coverage. Is that laughter we … Read more

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‘You Talking to Me?’ Docs and Feedback

Frank Diamond Managing Editor Collaboration is the name of the game these days, but even when lower-level providers speak up, will physicians really listen? So many innovative efforts in care delivery double back to the decades-old problem of physician buy-in. That’s true even as the Affordable Care Act moves from law to reality, or some … Read more

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Long wait time see obgyn

Forget about patients not refilling their prescriptions. Many don’t fill them the first time, according to a study in the Canadian journal Plos One (http://tinyurl.com/non-adherence-study). New prescriptions were given to 232 patients from April to August 2010 at St. Michael’s Hospital in Toronto. Twenty-eight percent exhibited primary non-adherence at 7 days after discharge; 24 percent at 30 … Read more

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Relapsing Multiple Sclerosis Patients Can Look to Second Oral Agent

The recent approval of Aubagio (teriflunomide) provides an opportunity to conduct head-to-head trials in this expanding treatment category Thomas Morrow, MD Multiple sclerosis, a debilitating immune disorder that affects the brain and spinal cord, was probably first described around 1200 in a young Icelandic woman named Halldora who suddenly lost her vision and mobility but … Read more

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Is 34 Weeks an Acceptable Goal For a Complicated Singleton Pregnancy?

J. Stephen Jones, MD McLeod Regional Medical Center, Florence, S.C. Niki B. Istwan, RN Department of Clinical Research, Matria Healthcare, Marietta, Ga. Debbie Jacques, MPH Department of Clinical Research, Matria Healthcare, Marietta, Ga. Suzanne K. Coleman, MSc Department of Clinical Research, Matria Healthcare, Marietta, Ga. Gary Stanziano, MD Department of Clinical Research, Matria Healthcare, Marietta, … Read more

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Iron replacement therapy works on kids too

The identification and treatment for iron deficiency can be a key public health objective. This analysis directed to produce an overview of using biomarkers to estimate the iron source inpatients given iron replacement therapy. A retrospective longitudinal real estate analysis of a cohort of patients undergoing iron replacement therapy has been conducted with data from … Read more

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One Thing It Won’t Be: ‘Business as Usual’

We hope that the big “2009” on our cover caused you to pause. To be sure, it’s an odd benchmark, even if it is a half-decade away. Goalposts placed five years apart hold a certain credence for those of us who spent our childhoods doing school drills in which we hid under desks. The “other … Read more

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Index of /archiveMC/9612

Name Last modified Size Description Parent Directory 04-Jan-98 21:46 – MC9612.clinicalsoft.s..16-Mar-97 22:56 17k ../../archiveMC/9612/MC9612.compmon.gif 16-Mar-97 22:56 27k MC9612.compmon.shtml 16-Mar-97 22:56 1k MC9612.contents.shtml 04-Nov-97 12:31 2k MC9612.employer.shtml 16-Mar-97 22:56 8k MC9612.ethics.shtml 16-Mar-97 22:56 7k MC9612.legal.shtml 16-Mar-97 22:56 8k MC9612.listen.frustr…16-Mar-97 22:56 4k ../../archiveMC/9612/MC9612.listen.rate.gif 16-Mar-97 22:56 7k MC9612.listening.shtml 16-Mar-97 22:56 21k MC9612.maneditorsmemo..16-Mar-97 22:56 3k ../../archiveMC/9612/MC9612.news.gif 16-Mar-97 22:56 8k … Read more

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Herzlinger’s ACO pcmh comments create storm

And Drug Administration declared the Lucentis® 0.3 milligrams prefilled syringe being a brand new way of restarting the medication to take care of most kinds of diabetic retinopathy. Back in April 20 17, Lucentis 0.3 milligrams became, and remains, the initial and just naturopathic medication to take care of most kinds of diabetic retinopathy in … Read more

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First ups drones deliver prescriptions CVS customers

UPS is rolling Together with its own drone shipping app, dealing together with partner CVS Pharmacy to send prescribed medication to customer door-steps by its newly deployed commercial drones. UPS delivered medications to just two paying clients around November inch with the Matternet m-2 drone system which the logistics company is operating in partnership with … Read more

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Beware of the CAR-T Hitches

CAR-T treatments are all the rage and showing some remarkable results. But the high price, along with the lack of long-term results, quiets the optimism. Navneet Majhail, MD, seldom sees medical developments as game changing. After all, medical progress tends to be a game of inching forward, not rewriting the rules. But the director of … Read more

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1/3 adults mixes supplements drugs

One in three Americans is Blending supplements with Prescription medicines, in accordance with fresh research and also the danger of potential interactions between medications and supplements is very important.In this nationwide representative sample of adults, 34.3 per cent reported with supplements and medications together. Adults identified as having a condition were 2.5 times more prone … Read more

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$50M for Drug Comparisons Could Produce Valuable Results

The Medicare amendment adopted late last year contains a provision that could help P&T committees, not to mention consumers, evaluate competing drugs. In all the brouhaha over the Medicare reform bill, one provision of the new law slipped into effect with barely a ripple: a $50 million authorization for the head-to-head testing of existing drugs. … Read more

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Fecal Microbiota Transplantation for Treating Recurrent Clostridium difficile Infection

A summary of ECRI Institute’s Emerging Technology Evidence Report Editor’s Note: Managed care leaders are striving to make evidence-based decisions about new and emerging health technology. Managed Care and ECRI Institute have collaborated to disseminate bimonthly summaries of the Institute’s Emerging Technology Evidence Reports. ECRI Institute is an independent not-for-profit organization that researches the best … Read more

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Health care’s forth and back while medical progress marches forward prescriptions

Microscopic structures look and move like bacteria For the past few years, scientists around the world have been studying ways to use miniature robots to treat a variety of diseases. The robots are designed to enter the human body, where they can deliver drugs at specific locations or perform precise procedures, such as clearing clogged … Read more

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More parents giving children dietary supplements

We climbed up at the Time of all Flintstones Multi Vitamins: We picked out of three bold colours, expected these to taste just like candies, winced in their medicinal aroma and sandy feel, and concealed them between the sofa cushions when our parents were not searching. That was pretty much itas much as dietary supplements … Read more

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Medicare To Take More of the Market

Much attention last month was given to the government’s projection contained in a Health Affairs study that national health spending will reach $10,000 per person per year for the first time this year. That was the lead in the New York Times, but the second paragraph probably caught the eye of clinician executives at health insurance companies. It … Read more

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Rejected Images–and The Lessons They Teach

Sometimes you can learn as much from the wastebaskets in a magazine’s office as you can from the gleaming new issues in the lobby. Notes from a meeting on this month’s cover are all that’s left of one editor’s proposal to symbolize the leisure time physicians gain when they accept a salaried position. That editor … Read more

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May 2001

Two Accrediting Organizations Prepare To Issue DM Standards It’s probable that one will become the dominant judge: NCQA or URAC. After it happens, will vendors undergo less scrutiny by individual plans? John Carroll Genetic Medicine: Powerful Opportunities For Good and Greed Genetic advances could spawn incredible improvements in health care. Given public demand, they also … Read more

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Health Plans by Design, Not by Default

Fortune 500 employers are ready to shed old benefit models for “managed consumerism” MargaretAnn Cross Contributing Editor Fortune 500 employers that are increasing health plan deductibles, adding coinsurance, and putting incentives in place to encourage employees to embrace healthy lifestyles are getting more involved in the details of health plan benefit design than they have … Read more

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Barriers to access attributed to formulary changes

Health insurers change their formularies to increase medical effectiveness and save money, and a new study from Case Western Reserve University has determined the effect these changes might have on patient care with respect to the prevalence of difficulty in filling a prescription and resultant problems. Questionnaires were mailed to 1,200 patients who had visited … Read more

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Why HMOs Could Thrive In the Economic Downturn

RECESSION-PROOF It happened in the slump of the early 1990s, and it could very well happen again. Managed care feasts while other industries starve. People will still get sick, even in bad times. Frank Diamond Senior Editor Whenever Alan Greenspan makes a pronouncement, lawmakers, pundits, and reporters parse the tortured syntax of the Fed chairman’s … Read more

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Polishing the Crystal Ball. How Far Have We Really Come in 2018?

Zachary Hafner:”For Your December 20 17 Dilemma of Managed Care, ” I Composed a piece titled,’Better for PatientsBetter for Business-Do We Need to Choose’? I submit a few predictions linked to vital trends for 2018. Now that we’ve gotten to the mid point of this calendar year, it’s a fitting time for you to sign … Read more

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Employers Take Stock of Illness on the Clock

Presenteeism — the condition of being on the job, but giving less than 100 percent — is fertile ground for health plans with a suitable product. About 100 physicians in South Charleston, W.Va., have been offered a stake in keeping 10,000 Dow Chemical employees as productive as they can be. By going the extra mile … Read more

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Generic Drug Price War Begins To Benefit Insurers

Steep discount programs encourage health plans to reduce, or even eliminate, copayments Martin Sipkoff Price wars involving generic drugs are widespread, affecting insurers, retail outlets, pharmacies, and consumers. Although consumer and insurer attitudes about the value of generics have become increasingly positive in the last couple of decades, the pricing of generics was never truly … Read more

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Preventive Care Drives Surge in Use of Clinics

Visits to retail clinics grew by a factor of four from 2007 to 2009, with patients getting preventive care during hours that most physician offices are closed, according to a study by Rand. The study also compares data from those years with an earlier study of retail clinic visits from 2000 to 2006. “Preventive care … Read more

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Economic Benefits of Improved Insulin Stability In Insulin Pumps

ABSTRACT Purpose: Insulin pump users discard unused medication and infusion sets according to labeling and manufacturer’s instructions. The stability labeling for insulin aspart [rDNA origin] (Novolog) was increased from two days to six. The associated savings was modeled from the perspective of a hypothetical one-million member health plan and the total United States population. Design: The discarded … Read more

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August 2009

Value-Based Insurance Design: Spend a Little More On Selected Patients For Payoff Down the Line Plans and payers are looking at a new insurance design that puts quality first. It might also save money. Use a Value-Based Strategy for Biotech Medications Coverage often straddles the line between the pharmacy and medical benefit, but a properly … Read more

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HMOs Would Be Wise To Investigate Alternative Ways To Improve Health

Human beings are not machines, and modern medicine needs to move beyond the repair shop mentality. Could nontraditional services help? Albert Einstein said that you cannot solve a problem with the kind of thinking that is creating the problem. Modeling our health care system after the machine repair shop has forced us to make difficult … Read more

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More Families Rely On State Insurance

More families are enrolling their children in state-funded public insurance programs like Medicaid and the State Children’s Health Insurance Program (SCHIP), says a new report from the Carsey Institute at the University of New Hampshire. The reasons are evident: job loss, coverage changes in private health insurance plans, and expanded access to public plans. The … Read more

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Joint Venture Health Plans May Give ACOs a Run for Their Money

They’re in the early stages of integrating regional clinical programs that expand treatment options for patients and facilitate effective population health management. Joint venture (JV) health plans created by insurers and health systems are often considered a tactic by the insurer to increase its market share. Anthem’s 2014 partnership with seven Los Angeles health systems … Read more

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A Few Clear Voices Will Always Rise Above the Din

Valedictories sound more or less the same. It’s as if there exists some metaphysical blender into which nervous speakers pour the usual suspects — “stand on the edge of a new beginning,” “with the foundation you’ve learned here,” “as I gaze out upon your hopeful faces,” “for everything there is a season” — add a … Read more

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Anthem’s push to have physicians take on two-sided risk lands at South Bend Clinic

“We are live at the South Bend Clinic in Indiana,” announces Mai Pham, MD, Anthem’s vice president of alignment solutions. She’s talking about the ACO’s implementation of Anthem’s newly launched Cooperative Care program in which the approximately 150 providers at South Bend take on two-sided risk. Pham spoke to Editor Peter Wehrwein in March 2018 … Read more

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Telemedicine: Cost-Effective Management of High-Risk Pregnancy

John Morrison, MD University of Mississippi Medical Center, Jackson, Miss. Niki K. Bergauer, RN, BS Matria Healthcare Department of Clinical Research, Marietta, Ga. Debbie Jacques, MPH Matria Healthcare Department of Clinical Research, Marietta, Ga. Suzanne K. Coleman, RNC, MSc Matria Healthcare Department of Clinical Research, Marietta, Ga. Gary J. Stanziano, MD Matria Healthcare Department of … Read more

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Master the ‘ABCs’ of Activity-Based Costing

How do you find out whether a given capitation rate will be profitable for your practice? Activity-based cost accounting is one tool that can help. An accountant explains how it works. The last 10 years have brought substantial changes to the health care industry. Managed care fee reimbursement structures have many physicians working harder, but … Read more

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A Conversation with Jeanne Scott: We Can’t Avoid Tough Decisions Forever

This former Reagan administration official is working to change how health information is processed. However, that’s only part of the solution. Jeanne Scott is on a mission of atonement. Back in the early Reagan years, she served as senior counsel in the Health Care Financing Administration’s Office of the General Counsel. Later, she came to … Read more

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Index of /archiveMC/9711

Name Last modified Size Description Parent Directory 28-Aug-2000 11:10 – ../../../../archiveMC/9711/QNA.1.GIF 17-May-2000 12:21 1k 9711.compmon.shtml 17-May-2000 12:19 1k 9711.outlook.shtml 17-May-2000 12:20 1k 9711.editorsmemo.shtml 17-May-2000 12:19 2k 9711.contents.shtml 17-May-2000 12:19 4k 9711.news.shtml 17-May-2000 12:20 7k 9711.legal.shtml 17-May-2000 12:20 7k 9711.washington.shtml 17-May-2000 12:21 8k 9711.employer.shtml 17-May-2000 12:19 8k 9711.ethics.shtml 17-May-2000 12:20 8k 9711.states.shtml 17-May-2000 12:21 8k ../../../../archiveMC/9711/9711.compmon.ext.gif … Read more

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Changing standard care treatment controlled substance crisis

The Venture team from Abt Associates Inc. Functioned as a Builder into the Centers for Disease Control and Prevention (CDC). Project Downline Sarah J. Shoemaker, Project Director, Health Services Researcher, PhD, PharmD; Douglas McDonald, Principal Associate, PhD; Leigh Mathias, Manager, MPH; Holly Swan, Associate, PhD; Nicole Keane, MS; along with Jahin Fayyaz, BS, directed the … Read more

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Employees increasingly inclined to enroll for benefits via Internet

Ready or not, more people are turning to the Internet to do everything from researching health conditions and medications to enrolling for benefits. Unfortunately, according to a report by the Commonwealth Fund, many health Web sites contain incomplete and even possibly inaccurate data. The report was conducted by researchers at the Massachusetts Health Data Consortium. … Read more

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Jimmy Kimmel Graham Cassidy Peter Bach car-T Dan Diamond tom price’s private jet travel

The frequency of these excursions underscores how personal traveling is now The standard — in the place of the exclusion — to the Georgia Republican throughout his tenure underneath the national health bureau, that began in February. Price’s usage of personal jets signifies a sharp departure from HHS officials also have said Price uses confidential … Read more

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‘New PARCA’ Doesn’t Placate Critics; Passage Prospects Going Down Tube

Is the Patient Access to Responsible Care Act, affectionately known as PARCA, dead? Let’s say its heart still may be beating, but faintly. Its chief proponent in the House, Georgia Republican Charles Norwood, did little to satisfy the naysayers with his revisions to the bill. Norwood recently redrafted PARCA to:   Remove language that could … Read more

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A Historical Perspective on Where We Are

Health and Human Services (HHS) just released data on 2010 health expenditures, reporting that we, as a nation, have now reached the $2.6 trillion mark, consuming 17.9% of our GDP. Reaching that new mark required 3.9% annual growth vs. 3.8% in 2009. On the surface, the rate of growth seems less alarming than the insurance … Read more

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The impact of molecular diagnostics on treatment pathways, outcomes, and cost

To Evaluate the operational and economic effects of executing a shorted diagnostic pathway during flu epidemics. Differences at room occupancy period at the ED and inpatient ward and also expenditure differences were computed to get its 14-week flu season. The process flow has been streamlined with the RDT pathway, and also the essential isolation period … Read more

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Too Many Books: How To Tell the Best Cooks?

The proliferation of clinical practice guidelines gives health plans plenty of models for developing their own. Which guidelines are better than others can depend on their creators’ methods and motives. Blue Cross Blue Shield of Massachusetts had a problem. Clinical awareness of sleep apnea was coming of age. Its physicians wanted to know what to … Read more

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Formulary Restrictions Inhibit Medication Adherence

If you haven’t already heard about the negative impact of formulary restrictions on adherence, well here it is. With mixed messages regarding formulary restrictions’ impact on patients, a recently published systematic literature review, published by Happe, et al., sought to get to the bottom this. It analyzed 93 studies published in 1993 or later and … Read more

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Payers Struggle to Ensure High Level of Adherence to Costly Specialty Drugs

Use of aggressive techniques to encourage patient adherence saves and improves lives and controls costs Martin Sipkoff Contributing Editor Former surgeon general C. Everett Koop, MD, famously said “Drugs don’t work in patients who don’t take them.” This is exceptionally true, with potentially terrible consequences, of specialty medications. “Medication adherence is particularly important for people … Read more

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Dealing With ‘Deal-Killers’ In Managed Care Contracts

Health plan executives as well as physicians can benefit from reading what this consultant has to say about the managed care contract clauses doctors should cross out and initial — or regard as “deal-killers.”   Perhaps the most prevalent of “deal-killer” provisions today is the “hold-harmless” clause. The hold-harmless clause essentially says that the physician … Read more

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Kaiser Official Defends Decision To Launch HSAs

In what appears to be a wrenching decision, Kaiser Permanente is gearing up to begin offering health savings accounts, something that some point out contradicts the health plan’s oft-stated philosophy that physicians, and not members’ financial needs, will direct medical care. HSAs were approved as part of the Medicare reform legislation passed by Congress about … Read more

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Medical Group to 590 Physicians: Take 10% Pay Cut or Get Out

A large Southern California medical group is telling its doctors to accept less money or find another source of patients. St. Joseph Medical Corp. of Orange, Calif., is demanding that its 590 doctors agree to changes in their contracts that would, in essence, lop about 10 percent off their pay. The group says it will … Read more

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Pain management health plans need take control

Emergency patients treated with naproxen and placebo had outcomes as good as or better than patients treated with naproxen and diazepam (Valium, Roche) for acute lower back pain, according to the results of a double-blind, randomized clinical study published in the Annals of Emergency Medicine. “Our study contributes to the growing body of literature indicating that, … Read more

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PBMs’ Rebate Income Threatened By Lawsuits and Move to Generics

A recent court settlement may affect the way the PBM industry makes profits, but could it also lead to higher drug costs?   Martin Sipkoff A recent $38.5 million settlement with 28 state attorneys general by CVS Caremark will cost the large PBM more than cash. Coupled with previous settlements in the industry, it will … Read more

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American Nurses Association

The American Nurses Association (ANA), through its 54 constituent member institutions say and territorial nurses associations along with also the Federal Nurses Association, may be the sole full-time professional firm representing the interests of their state’s 2.7 million registered nurses. In accordance with the ANA’s website, that the”ANA advances the nursing profession by fostering high … Read more

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Family Physicians Give Payers Middling Grades

With all the noise made by providers about report cards for physicians and quality grading systems undertaken by payers, it stands to reason that eventually, payers would be put under a microscope, too. Results of a survey conducted by the American Academy of Family Physicians and Family Practice Management magazine indicate that health plans have … Read more

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Medicaid cuts put rural hospitals in crosshairs

Tens of thousands of rural U.S. hospitals trying hard to remain in operation, Health policy choices made in Washington, D.C., that summer can make survival a great deal rougher. As 2010, at 79 rural colleges have shut around the Country, and almost 700 more are in danger of closing. These associations serve a mainly elderly, … Read more

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September 2014

Do We Overspend on Health Care, Underspend on Social Needs? Until recently, health plans have all but ignored the social determinants of health Health Plans’ Success Mixed In Managing Cancer Care Programs They too often focus narrowly on the work of oncologists, when a much more comprehensive approach is needed Oy Vey! A Cartoonist’s Take … Read more

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‘Prenuptial’ Planning for Your Next Managed Care Contract

By Michael J. Folio, J.D. It may sound silly, but managed care contracting is a marriage, a form of medical matrimony. And what do couples do before getting hitched? Date, meet the parents and discuss all those important issues: kids, careers, religion, goals. Likewise, before you don your formal garb and dance down the aisle … Read more

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Should You Use E-mail in Clinical Practice?

SYSTEMS & SOFTWARE Should You Use E-mail in Clinical Practice? Joyce R. Ochs When the American Medical Association published e-mail guidelines for doctors last year, it was a tacit acknowledgment that the ubiquitous medium had found a place in the mainstream of medical practice. The issue today is no longer whether to do it (it’s … Read more

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A Conversation with Michael J. Dillon, R.Ph.

The executive director of the Foundation for Managed Care Pharmacy speaks of the challenge of reining in escalating drug costs. Michael J. Dillon has been in the front lines of the explosive growth of managed care and its effect on pharmacy over the last two decades. He began his career in 1979 as a staff … Read more

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PharmD Corner

Up and Up They Go. Can Drug Prices Be Brought Down to Earth in 2019? It’s no secret that list prices for prescription drugs are increasing. Every year, pharmaceutical companies are raising their prices whether it is for brand drugs or generics. Novel therapies, often for rare diseases, are coming on the market priced at … Read more

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Health Plans That Decredential Docs Must Do It Correctly and Expect a Fight

Bruce J. Goldstein, J.D. Mark D. Abruzzo, J.D. Last month, we advised physicians not to allow themselves to be decredentialed without putting up a fight. This month, we advise managed care organizations that, well, physicians are going to fight decredentialing — and as a result, MCOs should approach this process very carefully. There are many … Read more

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Lowball Insurance Plans Fail To Respond to Georgia’s Invitation

The idea is that selling policies across state lines will lower costs and increase the number of insured, but it hasn’t worked that way yet John Carroll Last year the Georgia legislature passed a law that gave conservatives a big victory in their fight against health care reform. The state allowed the sale of interstate … Read more

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The Power of Perspective

John Cassis   John Cassis: “Roy Dyson said, ‘Yesterday is history, tomorrow’s a mystery, but today’s a gift. That’s why they call it the present.’ Savor this day, this gift.” John Cassis is founder and president of the Cassis Group. A motivational speaker, Cassis’s occupations and avocations have ranged from minister to publisher and entrepreneur. For … Read more

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Health Management Uses IT To Reduce Future Costs

Payers must manage the care of all members, regardless of how sick or well, to control escalating treatment expenditures Jackie Mazoway PricewaterhouseCoopers Hard hit by the recession, employers of all sizes are reassessing the value they are getting from their health plans. Their conclusion? It is not enough. Employers want more — greater value, better … Read more

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Psychology

You’ve Got to Believe: The Evidence on Positive Thinking in Cancer Outcomes Submitted by Steven Peskin MD on Sat, 2011-12-10 19:41 Steven R. Peskin, MD, MBA, FACP is executive vice president and chief medical officer of MediMedia USA, which publishes Managed Care Mark Herzlich, Boston College All American linebacker and now New York Giants rookie, … Read more

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Doctors Bypassed As More Medicine Purchased Online

The Internet is becoming a vehicle for black-market sales of prescription drugs. Government officials are cautioning consumers they may be risking their lives — while warning doctors they may be risking their careers — by participating. For those who want pharmaceuticals not yet approved for sale in the U.S., whose HMOs will dispense only a … Read more

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July 2015

Tools for Taking the Measure of Cancer Drugs Ed Silverman Tuning in to Telemedicine With videoconferencing, text messaging, email, and the good old phone call, a treatment method that “spent many years in the desert” has now reached an oasis of acceptance—and savings may result. Susan Ladika Cost, Outcomes Mixed for Tele-ICU ICUs are expensive, … Read more

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Quality-Measurement Organizations Look Beyond HMO and POS Plans

LOOKING FORWARD For other articles in the series, see listing at end Now that the hard part — forging quality-measurement systems for HMOs and point-of-service plans — has been done, the next step is to adapt these programs to the rest of the health care industry. Margaret E. O’Kane Twenty years ago, when fee-for-service practice … Read more

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Health Plan Joins With Physical Therapy Facility to Manage Back and Neck Pain

Capital Health Plan achieved a 79% improvement in pain scores and a 54% improvement in function scores for its members Abstract Twenty-five billion dollars is spent each year on the medical care of back pain, and $50 billion is lost in productivity. Primary care physicians might have difficulty providing thorough counseling and treatment to their … Read more

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The Private Sector Can, Should, and Will Help Solve the Problem of the Uninsured

WellPoint Chairman Leonard Schaeffer and other health plan leaders believe they can help with a chronic societal issue The fact that 48 million Americans are without health insurance has indisputable economic and social consequences. Bad debt, disproportionate use of emergency medical services, lack of preventive care, amplified morbidity and mortality rates, loss of productivity — … Read more

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What the Devil Is Information Therapy?

Too often, the patient doesn’t learn — or doesn’t remember — important things that can speed recovery When Ted Eytan, MD, treats a patient with a broken rib, he positions the computer screen in the exam room so that his patient can look at the X-ray. He describes what the image shows, then clicks to … Read more

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Flat Tax? Single Payer? Find Those Easy Answers

Intelligent and articulate. Those are two adjectives I can use to describe Steve Forbes, a man who thinks he should be president of all the country. I try to get to the National Managed Healthcare Congress every year because many speakers share their knowledge of cutting-edge health care issues. I get to meet people I’ve … Read more

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Drug Giants Turn to Leading Professors to Justify Hefty Price Tags

“Academics for hire” shape pricing debate To help promote their expensive new cures for infection with the hepatitis C virus (HCV), three major pharma companies––AbbVie, Bristol-Myers Squibb, and Gilead Sciences––recruited the consulting firm Precision Health Economics, whose roster includes leading economists and health care experts at the nation’s top universities. When AbbVie funded a special … Read more

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P4P: Transitional at Best

Pay-for-performance (P4P) programs promise a fair shake for provider and plan, but a former chairman of the NCQA sees many design flaws to overcome. Alice G. Gosfield, JD Pay for Performance (P4P) programs are springing up all over the country in direct response to the failure of existing payment methodologies to produce optimal quality levels. … Read more

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Medication Therapy Management Program in N.C. Saves $13 Million

Health plans are expanding MTM — once considered a Part D mainstay — to their commercial businesses. Thomas Reinke MANAGED CARE October 2011. ©MediMedia USA Health plans are expanding MTM — once considered a Part D mainstay — to their commercial businesses. Thomas Reinke Results from an ongoing North Carolina medication therapy management program show just how … Read more

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Cut Pharmaceutical Costs, But Mind the Legal Dangers

Health plans and physicians have every right to hold down the cost of pharmaceuticals, as long as patients aren’t harmed. But not everyone agrees on what actions are acceptable. Many managed care organizations believe that cost containment can be achieved in part or whole by restricting the drug choice of both health care practitioners and … Read more

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Reducing Bariatric Readmissions

About two-thirds of readmissions are preventable   With a mortality rate of 0.1% and relatively few complications, 30-day readmissions represent one area in which bariatric surgery programs could improve, according to an article in the January/February 2016 issue of HealthLeaders magazine. About two-thirds of bariatric readmissions are preventable, the article says, and the most common reasons for … Read more

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The Comeback Isn’t Complete: HMOs Still Shaky

The Hay Group’s annual benefits report found that health insurance premiums rose 5.2 percent in 1999, but not necessarily because insurers were trying to boost their bottom lines. Rather, the consulting firm attributes most of that rise to the soaring cost of prescription drugs — up 15 percent, by Hay’s estimate. Though the year began … Read more

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Providers, Plans Misinformed About Vendor Software Capability

This past March, health care providers, health plans, and other organizations subject to HIPAA regulations were given some breathing space in their race to meet the Oct. 16, 2002, deadline for compliance with the HIPAA electronic transactions rule. The Centers for Medicare and Medicaid Services (CMS) — the agency within the Department of Health and … Read more

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Quality improvement organizations short stay audits dig deep

It’s A more frequent word of reinforcement you’ll hear from coworkers once they determine you are confronting an ISO audit. Obviously, trusting in fortune isn’t a fantastic strategy for that far online. You ought to prepare yourself every manner possible therefore that fortune wont play in to the consequences. And among the greatest methods to … Read more

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Heart Failure Treatment Gaps Costs Lives, Hikes Expenses

Health insurance plans need only bolster the following accepted guidelines to see a return on a very little bit of investment Bob Kirsch Heart failure results in substantial morbidity, mortality, and health care expenditures. There are 5.8 million people in the United States with heart failure, and this condition has one of the highest rates … Read more

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Trump meet vaping industry reps

President Trump said Monday he would talk vaping-industry agents as he chose which will pub earnings of candy, fruit-flavored e cigarettes targeted toward young men and women, increasing concerns among public health urges the step might possibly be diluted. “will be meeting representatives of this Vaping industry, along with doctors and respective nation agents, to … Read more

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August 2012

Cover Story For Health Insurers, Retail Space Available! Under health reform, consumers will be the new buyers in public and private exchanges, meaning care management programs will need a sharper focus on return on investment Joseph Burns Health Plans Won’t Sit Out While Docs, Hospitals Dance As providers scramble to form accountable care organizations, insurers … Read more

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N.J.’s Takeover Of Failed HMO Assuages Docs

Three weeks after taking over HIP Health Plan’s bankrupt New Jersey unit, state regulators reached an agreement with the Medical Society of New Jersey that kept its physicians from making good on a threat to refuse treatment to nonhospitalized HIP members. It is estimated that physicians and hospitals are owed $100 million for care to … Read more

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Effective Ways To Increase Usage of Generics

It’s one of the few areas where plans can economize effectively. BlueCross & BlueShield of North Carolina is one of many insurers that are changing members’ and prescribers’ behavior. John Carroll Contributing Editor Last year, BlueCross & BlueShield of North Carolina tailored a new offer of generic drugs that was designed to break a critical … Read more

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2016 could be the year that value-based payment arrives–or maybe not

Worldwide, there’s dissatisfaction with all current, input-oriented along with supply-led healthcare systems. These procedures are inundated by monodisciplinary and coordinated maintenance and effect in fragmented care procedures, suboptimal quality and waste of funds. There’s consensus that faulty provider payment techniques donate for the issue. Specifically, overriding payment techniques create significant incentives for healthcare providers about … Read more

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AWP Reimbursement Ruling May Be More Than Meets Eye

The managed care industry says that the ramifications of the Supreme Court decision will be slight. But could that be just wishful thinking? When the Supreme Court recently came down solidly on the side of Kentucky’s “any willing provider” statute, industry leaders quickly shrugged off any major implications. “Today’s ruling by the U.S. Supreme Court … Read more

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Rates for HEDIS Screening for Diabetic Nephropathy Quality Measure May Be Overstated

This analysis assessed the appropriateness of this prescription medication compliance measure for that Medical Care for Nephropathy grade step for patients who have diabetes. Data from federal industrial asserts for 28,348,363 men were evaluated. The analysis employed the typical HEDIS criteria for compliance with medical care for nephropathy for diabetics. Assessment of this next and … Read more

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Index of /archiveMC/9808

Name Last modified Size Description Parent Directory 30-Sep-2000 10:40 – 9808.compmon.gif 06-Jul-1999 09:03 51k ../../../../archiveMC/9808/9808.compmon.pdf 06-Jul-1999 09:03 45k ../../../../archiveMC/9808/9808.news_docreport.gif 06-Jul-1999 09:04 37k ../../../../archiveMC/9808/9808.news_riskchart.gif 06-Jul-1999 09:04 18k 9808.outlook.gif 06-Jul-1999 09:05 53k ../../../../archiveMC/9808/9808.outlook.pdf 06-Jul-1999 09:05 44k 9808.truce_gatechart..> 06-Jul-1999 09:06 16k 9808.compmon.shtml 29-May-2000 11:52 2k 9808.contents.shtml 29-May-2000 11:52 5k 9808.downturn.shtml 29-May-2000 11:52 15k 9808.editorsmemo.shtml 29-May-2000 11:52 3k 9808.ethics.shtml … Read more

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Court Ruling May Mean Resolution Or Revolution

A key federal court ruling was expected at press time on a series of lawsuits against the HMO industry. Additionally, the nation’s largest managed care operator reportedly is negotiating a settlement. The convergence may determine whether HMOs can put the worst of their legal issues behind them — or if the gates are opened wide … Read more

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What do you do about ER costs?

If You Think like Most Americans, the Very Thought of a ER Trip is Really a Frightful Proposal; maybe perhaps not merely on account of the unexpected crisis nasal circumstance but outside of an awareness of worry to be over charged for products and providers. Medical maintenance prices for emergency services be seemingly rising every … Read more

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Meal tickets for better health, lower costs

Deliver ‘medically tailored’ meals that take into account the nutritional needs of people with chronic illnesses. They will stay healthier and avoid expensive hospital care. Ask David Waters, CEO of a Boston-area not-for-profit organization called Community Servings, about America’s high-cost patients. He doesn’t talk about medications. He doesn’t talk about trips to the emergency department … Read more

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The Role of Physicians In Disease Management

At its best, disease management is neither a turf protector for specialists nor a marketing vehicle for drug companies. It’s a common-sense approach to unifying care for a condition, and it depends on primary care physicians. For a moment, imagine health care providers as the members of a big-city orchestra. Primary care physicians, specialists, nurses … Read more

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April 2008

Mental Health Parity: At Long Last? A coalition of employers, legislators, consumer advocates, health plans, and drug companies may bring about equal coverage Martin Sipkoff Insurers and Oncologists Forge a Better Cancer Drug Policy The goal is to keep oncologists from relying on drug markups to keep their incomes high, but it’s slow going Lola … Read more

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FDA approves synjardy xr adults type 2 diabetes

The FDA has declared Synjardy XR pills for the treatment of type two diabetes in older people. In conjunction with exercise and diet, Synjardy XR may increase blood glucose. Synjardy XR comprises equally equally empagliflozin along with metformin. Empagliflozin can be really actually just a sodium-glucose cotransporter two inhibitor that eliminates surplus sugar as a … Read more

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Effects of rising malpractice premiums said to be overstated

A recent report by the U.S. General Accounting Office caused much discussion recently by challenging the contention that physicians are moving out of states in which medical malpractice insurance premiums have risen steeply. The GAO found that “many of the reported provider actions were not substantiated or did not affect access to health care on … Read more

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The Attorney-Client Privilege: What It Does and Doesn’t Cover

Our last two columns discussed ways physicians may share information among themselves and with purchasers without running afoul of antitrust law and other legal rules. This month we explore how to keep shared information confidential. The attorney-client privilege protects certain communications between an attorney and his or her clients. When it is in place, no … Read more

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Price not greatest concern in medical travel

Although the price difference between procedures performed in the United States and in developing countries might suggest that U.S. payers could gain if they extend their coverage to include treatments abroad, there are a number of factors holding back the flood of medical travelers. They include the inaccessibility of networks of providers in some medical-travel … Read more

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Ruxolitinib capecitabine combo shows insufficient efficacy pancreatic cancer

Capecitabine increased overall survival versus capecitabine at a subgroup analysis of patients with metastatic pancreatic cancer and systemic inflammation at the esophageal stage II re-cap study. We report results from two phase III studies, JANUS inch and also JANUS 2. The main end point has been OS. Results The two studies were conducted after having … Read more

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When Personal and Professional Collide

When a pharmacist — for personal beliefs — refuses to fill a prescription, the health plan should be very concerned. The reason we evolved with two ears is because we survive better if we can hear two sides of an argument. This talent comes in handy in analyzing the ruckus over pharmacists refusing to provide … Read more

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New Type of Pill Prolongs Drug Release

Researchers at the Massachusetts Institute of Technology (MIT) and Brigham and Women’s Hospital in Boston have designed a new type of pill that, once swallowed, can attach to the lining of the gastrointestinal (GI) tract and slowly release its contents. The tablet is engineered so that one side adheres to tissue, while the other side … Read more

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HMOs Would Be Wise To Investigate Alternative Ways To Improve Health

Human beings are not machines, and modern medicine needs to move beyond the repair shop mentality. Could nontraditional services help? Albert Einstein said that you cannot solve a problem with the kind of thinking that is creating the problem. Modeling our health care system after the machine repair shop has forced us to make difficult … Read more

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Gives Some Pause About Checkpoint Inhibitors: Possible Link to Type 1 Diabetes

One percent of patients undergoing immunotherapy for cancer develop type 1 diabetes, what Mario Sznol, MD, an oncologist at Yale School of Medicine, described in Stat as an “unfortunate trade-off.” Sznol is treating Rich Lenihan with checkpoint inhibitors for Lenihan’s skin cancer. Jamie Vidal, who is not one of Sznol’s patients but whose diabetes also resulted from … Read more

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Laws Governing Peer Immunity, Physician Credentialing Upheld

Donna J. Senft MANAGED CARE February 2002. ©MediMedia USA Donna J. Senft A federal court in Maryland recently addressed challenges to several laws governing physician credentialing. The challenges arose when a physician whose hospital privileges were revoked filed a civil action against the hospital and 14 individuals involved in its credentialing process, along with the state of … Read more

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DNA based zika vaccine safe effective phase 1 testing

The hypotheses were that the ZIKVwt DNA vaccine could be safe also could elicit a ZIKV-specific resistant reaction. Participants received study product intramuscularly from the limbs according to the group mission by PharmaJet needle-free gadget. Back in Part A, 90 participants were randomized to medication at a 1:1:1 ratio to obtain a 4 mg dose … Read more

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Florida Physicians Sue Prudential, May Form Union

The Florida Medical Association and other physician groups in the state have sued Prudential Health Care Plan, charging that the HMO has illegally denied claims or delayed payment. The North Florida Obstetrical & Gynecological Association and the Florida Physicians Association joined in the suit, filed in late July in Duval County Court. The suit claims … Read more

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Seven Therapeutic Categories Account for Most Drug Cost Increases

Over the next three years, more than 80 percent of drug costs will be concentrated in seven therapeutic categories, according to Medco Health Solutions. However, drugs for the central nervous system and endocrine/diabetes drugs will account for almost 40 percent of spending growth. “Pharmacy directors at health insurance plans can develop more effective plan strategies … Read more

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How Managed Care Affects the Malpractice Liability Problem

Managed care has the potential not just to achieve savings, but to improve health care outcomes dramatically. But does it create extra malpractice complications along the way? The experts have different views. You might call the Austin Regional Clinic in Austin, Texas, an anomaly, an exception to the conventional wisdom about managed care. The clinic, … Read more

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2011

January 2011 February 2011 March 2011 April 2011 May 2011 June 2011 July 2011 August 2011 September 2011 October 2011 November 2011 December 2011 Paul LendnerPaul Lendner ist ein praktizierender Experte im Bereich Gesundheit, Medizin und Fitness. Er schreibt bereits seit über 5 Jahren für das Managed Care Mag. Mit seinen Artikeln, die einen einzigartigen … Read more

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Prescriptions for generic drugs rise sharply

Prescriptions for generic drugs rose sharply from 2008 and 2009, with generics jumping from 52.4 percent to 57 percent of all prescriptions. The sharp rise is linked to any number of factors, including the sluggish economy, increased coverage of over-the-counter medications, and more Medicare beneficiaries reaching the coverage gap (aka the doughnut hole), according to … Read more

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Hammurabi’s Managed Health Care – Circa 1700 B.C.

By Allen D. Spiegel, Ph.D. AT THE DAWN OF CIVILIZATION, about 4,000 years ago, nomadic Semite tribes developed a managed health care system. Using cuneiform, a hieroglyphic writing, they inscribed the concepts on clay tablets and chiseled them into stone between the 17th and 21st centuries B.C. Adapting the existing edicts, King Hammurabi of Babylon … Read more

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March 1997

In Five Key Clinical Areas — What Falls Through The Cracks When Quality Is Measured? The idea of evidence-based medicine lies at the heart of managed care. But looking only at today’s fairly crude quality indices would be like measuring a diamond with a tape measure. Does pressure for ever-improving quality ‘scores’ endanger the real … Read more

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Home hospital halves costs

Hospital at home is an Atmosphere in Which chosen kinds of healthcare might be delivered at your house to acceptable, consenting patients that require in patient clinic maintenance. Increasing financial pressure in hospitals, in addition to patient choice, has driven the evolution of HITH like a workable choice for supply of acute care, both in … Read more

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Medicaid Managed Care Braces for New Regulations

New regulations for managed Medicaid promise to shake up an industry that, apparently, needs very much to be shaken up. The implications of last week’s Kaiser Family Foundation (KFF) report (http://files.kff.org/attachment/issue-brief-reading-the-stars-nursing-home-quality-star-ratings-nationally-and-by-state) on the state of nursing homes (hint: not so good) builds even more anticipation about CMS’ plan to unveil the regulations any day now. … Read more

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Population Care Coordinators: A Key to Improved Care at Lower Cost?

In New Jersey, Horizon’s patient-centered medical home program puts data-savvy nurses in primary care practices to reach out to high-risk patients and forestall costly crises Trying to save money in health care isn’t new to Sandra Siegel, RN. A nurse with 30 years’ experience, she remembers working for a managed care company in the ’90s … Read more

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Speaking the Unspeakable: How Plans Can Deal With the Dying

PALLIATIVE CARE Physicians don’t like to discuss end-of-life care. Neither do health plans, fearing it makes them look cold. A few plans are finding innovative ways to do it. John Carroll Contributing Editor Trained as a geriatrician, Minneapolis M.D. Edward Ratner had years of firsthand experience dealing with dying patients. But when his own daughter … Read more

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IOM: Medication Errors Rampant, And Preventable

The Institute of Medicine periodically unveils research that resonates long after thousands of other studies and reports published each year about health care have been ground to a pulp for the benefit of the planet, if not planetary intelligence. Crossing the Quality Chasm and To Err Is Human — they have become classics in the … Read more

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June 2000

Prepaid Care, Third-World Style: The Uganda Health Cooperative Minnesota-based HealthPartners works with local leaders in a successful initiative to improve health care in a developing African country. Physician Financial Incentives: Another UM Tool Bites the Dust The managed care backlash has claimed another casualty: Financial incentives in physician contracts as a means of controlling utilization. Is … Read more

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Tackling Antibiotic Overuse Through Accountable Care

FEATURE Tackling Antibiotic Overuse Through Accountable Care Insurers and ACOs should be able to work together to tackle a problem that wastes as much as $42 billion a year Thomas Reinke Contributing Editor The long list of strategies to combat antibiotic overuse that leads to drug-resistant superbugs is proving to be a tug of war. … Read more

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The reviews are in! CMS Rating of Hospitals Gets 1.5 Stars

Factoring in the sociodemographics of patients might help improve them. But so would more transparency and openness by the hospitals.   Say what you will about the CMS hospital star ratings—and much has been said about them, mostly disparaging—their release accomplished something that’s a rarity in Washington these days: Republicans and Democrats in Congress came … Read more

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Violence Against Nurses: Casualties of Caring

Sometimes patients are angry. Sometimes it is a symptom of their illness. Either way, nurses are on the front lines of health care and bear the brunt of the physical and verbal abuse from patients; gender may be a factor. In California, hospitals and other health care providers are now required to keep a log … Read more

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How To Combat Pharma’s Costly Coupon Programs

When drug manufacturer coupons make members’ costs for brand drugs equal to generics — or less — health plans, employers, PBMs, and members pay a price Health plans that are trying to control their prescription coverage costs must act as if they are engaged in the game of whack-a-mole: They must be continuously ready to … Read more

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Geisinger CABG warranty. A worthwhile experiment

That’s a hospital group at central Pennsylvania is hoping to learn within a test that a number of experts say is a radically new means to encourage physicians and hospitals to present supreme quality maintenance which may avoid expensive mistakes. The team, Geisinger Health System, has spawned its way of operation. And taking a cue … Read more

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HMOs’ Protection From Liability Chipped Away, Ruling by Ruling

A federal court in New Orleans has ruled that members may take their HMOs to state court if they are unhappy with their care. The decision, however, does not allow patients to sue over denials of coverage.A three-judge panel on the Fifth Circuit Court of Appeals said that Texas resident Bridgett Giles could sue NYLCare … Read more

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Plans’ pharmacy costs to rise as much this year as in 1999

The Segal Co., a New York-based consultant to employers, estimates an 18-percent increase in the cost of providing a pharmacy benefit this year. Prescription-drug claim expenses are expected to consume 15 percent of all costs of providing health benefits to active employees and retirees under age 65, and 40 percent of the cost for retirees … Read more

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December 2008

Countdown Nears for Launch of ICD-10 This new code set promises to delineate like never before the type of physician service rendered Frank Diamond Price Hikes Spur Part D Debate As premiums soar, the new Democratic majority weighs the benefits of restrictive regulation vs. the free market John Carroll Health Insurers Well Positioned, But Must … Read more

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The cost of cancer: new drugs show success at a steep price

Newer cancer drugs which enlist your body’s immunity system are improving the probability of survival, however rivalry between them just isn’t reining at prices which could currently top $250,000 annually. A’s pipeline of cancer medication enlarged by 63 per cent between 2005 and 2015, as stated by the QuintilesIMS Institute, and also a fantastic portion … Read more

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For Pharmacists: Reimbursement In Medicare Bill

Pharmacists would be added to the list of professionals considered “health care providers” under the Social Security Act if a bill introduced by South Dakota Democratic Sen. Tim Johnson becomes law. Such a designation would allow pharmacists to bill Medicare for professional services. Consultant pharmacists have long sought provider status, noting their medication-management skills for … Read more

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Aloha State Never Expected Such a Long Goodbye to Uninsured

Three decades after Hawaii was supposed to have put a controversial end to a chronic problem by making employers cover more people, guess what persists? John Carroll MANAGED CARE December 2003. ©MediMedia USA Three decades after Hawaii was supposed to have put a controversial end to a chronic problem by making employers cover more people, guess what … Read more

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Medicare’s Efficiency Over-Hyped, Study Claims

The belief that Medicare is a more efficient system than employee-sponsored health insurance comes under fire in a study that claims there are hidden costs in the government program. “One of the most common, and least challenged, assertions in the debate over U.S. health care policy is that Medicare administrative costs are about 2 percent … Read more

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Is Home Infusion Ready for Prime Time?

Advanced therapy management may lead to physician acceptance of additional medications infused at home Home infusion has been around for over 30 years, but it is a service that has never really taken off. Effective infusion drugs have been developed for acute conditions, but home infusion has been relegated to less glamorous uses such as … Read more

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AMA Slams Managed Care Even As Leadership Splinters

LOBBYING FRONT The wild calls for patients’ rights at the House of Delegates meeting did not prevent the chief executive from suing the board of trustees. Contributing Editor Health Secretary Tommy Thompson was playing to a tough Chicago house. His message was simple: Congress needs to soften the legal blows delivered to managed care under … Read more

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Insurers Get Involved in Campaign Against Hospital-Acquired Infections

Plans prod hospitals to do a better job of addressing problems that kill nearly 100,000 Americans a year As the public reels from the new estimate that nearly 100,000 Americans are dying each year from infections associated with health care, some health plans are taking a lead in alleviating the problem in their markets. “The … Read more

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To get or to skip care? Coverage makes the difference

Not surprisingly, many uninsured adults either do not get or postpone care they need. But a recent Kaiser/Commonwealth Fund survey suggests that adults who receive Medicaid benefits also skip or put off care — and that, because of expense, adult Medicaid patients are less likely to fill prescriptions than those without insurance — despite the … Read more

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Anthem cites sdoh offerings boost medicare advantage gains

The age of the “Super Blues” may be dawning, thanks to the consolidation of Blue Cross and Blue Shield health plans. That’s the opinion of some experts after Anthem’s $4 billion purchase of Trigon Health Care. There are 43 Blues plans today, far fewer than what existed in earlier years. Mike Taylor, a principal with … Read more

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Drug-Eluting Stents To Transform Cardiovascular Medicine

By reducing restenosis, these devices will save managed care money. Technophiles would be hard pressed to come up with better names than Cypher, Cypher Stallion, Achieve, Taxus, Express and Maverick. But it is unlikely that most managed care executives would guess that these names represent an industry that, up until now, has been neglected by … Read more

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African-Americans Die Younger Due to Heart Disease, Stroke

Socioeconomic status doesn’t explain all the discrepancies The average lifespan of African-Americans is significantly shorter than that of white Americans mostly because of heart disease and stroke, which contributed to the loss of more than two million years of life among African-Americans between 1999 and 2010, according to a new scientific statement published in the … Read more

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HSA Rolls Continue to Grow, Up 14% From Last Year

Health savings account (HSA) insurance plans continue to thrive, with more than 11.4 million Americans covered, up 14 percent from last year alone. HSAs were launched in January 2004, authorized by the Medicare Prescription Drug Improvement and Modernization Act of 2003. Since then, America’s Health Insurance Plans (AHIP) has conducted annual surveys to keep track … Read more

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Supremes have spoken and aca keeps hangin

Destroy the trademark achievement of this Obama government — that the Affordable Care Act, better called Obamacare. Exactly 1 week later election , they may possibly triumph. After a election season unlike any other, at the midst of a stunt, the ultimate court would hear a case which may end in 20 million Americans losing … Read more

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Popular content

POPULAR CONTENT TODAY’S POPULAR CONTENT Type Title Author Story When Is a Brand a Generic? In a Contract With a PBM webadmin Story A Conversation With Sharon Levine, MD: Last Chance to Avoid Drastic Measures? webadmin Story How Plans Can Improve Outcomes And Cut Costs for Preterm Infant Care webadmin Story Medical Directors Explain Hows … Read more

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Gop considers four obamacare replacement measures

Improving cardiac surgery outcomes for both adults and children is the goal of 21 quality measures recently endorsed by the National Quality Forum. The measures spring from two NQF “endorsement projects”: Surgery Endorsement Maintenance 2010, Phase 1, and the National Voluntary Consensus Standards for Pediatric Cardiac Surgery. “NQF endorses national consensus measures in health care … Read more

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Lawsuits Track New Flare-ups In Insurer/Doctor Relationship

John Marcille There’s a lot about technology in this issue. A story examines how health plans are dealing with the genomics revolution. Read about some amazing patient-monitoring systems that promise a bright future for disease management. Then get a glimpse at how information technology might at last foster greater cooperation between health plans and provider networks. I say … Read more

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Are Gatekeepers Failing To Control Specialty Costs?

The importance of a gatekeeper in keeping costs down has been challenged again — this time in a study that compares physician utilization for HMOs and point-of-service plans. The study, sponsored by the U.S. Agency for Healthcare Research and Quality, found no evidence that HMOs that use primary care physicians as gatekeepers keep specialty costs … Read more

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Clinicians identify and biopsy suspicious lesions

Family physicians have a chance to diagnose varicose lesions premature with a biopsy that is timely. To check current biopsy clinics utilised by FPs in assessing melanoma. A Computer-generated arbitrary sample of 200 Profession FPs from large and tiny communities in Ontario was identified by the College of Physicians and Surgeons of Ontario doctor directory. … Read more

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Why bundled payments are poised to take off

BPCI Advanced signals a willingness among Medicare providers to redesign care and take on risk. Commercial payers are watching closely. “We can never go back again, that much is certain,” wrote Daphne du Maurier in her 1938 novel Rebecca. Eighty years later, Du Maurier’s observation is just as fresh when looking at the uptake of value-based … Read more

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Forever Young

As a baby boomer moving through middle age into the unspeakable age that follows “middle,” I was encouraged to read an article in the British Medical Journal that states that for seniors and super seniors, healthy behaviors that include regular exercise, not smoking, maintaining a normal Body Mass Index, and having a rich or moderate social … Read more

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Don’t Be Caught Off Guard If Government Comes Calling

Neil Caesar, J.D. Dark-suited gentlemen stride purposefully into your reception area and ask to see the person in charge. The visitors announce that they are with the federal government — the U.S. Attorney’s Office, or the FBI, or the Office of Inspector General — and that they have a warrant to seize documents and other … Read more

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Headlines on Deadline…

Six California companies have begun paying physicians $20 for e-mail “visits” with patients…. More than half of HMO patients surveyed in an Archives of Internal Medicine study worry that capitation compromises quality of care…. Aetna admits that poor record keeping and incommunicative computer systems led it to pay millions in benefits in recent years to … Read more

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Transforming Dyslipidemia Management: Assessing Clinical Outcomes and Cost Transforming Dyslipidemia Management: Assessing Clinical Outcomes and Cost

Download supplement The basis of this supplement is the 2003 Medical Director Colloquy, a forum for interaction between top medical managers and a nationally renowned faculty of medical and business professionals. Decision makers in managed care have a range of critical concerns relative to dyslipidemia treatment efficacy, cost, and options. This supplement allows readers to … Read more

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Comparing congressional health care proposals

A review of health care reform bills proposed by Congress shows that many of them would cover more uninsured Americans than the current administration proposal. The review, conducted by the Lewin Group on behalf of the Commonwealth Fund Commission, determined that in addition to reducing the number of uninsured Americans, the proposals would also decrease … Read more

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Prescription Contraceptives: Benefit Whose Time Has Come?

Michael J. Friedman Health plans and employers are paying increasing attention to recent administrative and judicial developments relative to contraception coverage. Whether self-funded or insured, plans that offer prescription drug benefits may no longer be able to exclude prescription contraceptive drugs or devices. Thirteen states require insurance policies specifically to cover contraceptive drugs or devices. … Read more

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Formulary Submission Process Catches On … Slowly

If drug purchasers are so bullish on what the AMCP format can do for them, why don’t more of them use it? MargaretAnn Cross Contributing Editor In a side-by-side cost analysis with other medications, Altace looks expensive. But for a defined population of high-risk patients with hypertension, this ACE inhibitor may have a leg up … Read more

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Opinions on DM Outcomes Can Be Swayed

An exercise in “point-counterpoint” at a recent disease management meeting showed dramatic swings in views *Four members of the National Managed Health Care Congress (NMHCC) Disease Management Outcomes Workgroup debated the pros and cons of six different issues before a group of knowledgeable listeners, and discovered that even in a short period, opinions could change … Read more

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7 Things You Should Know About the AHCA

The official name is the American Health Care Act and so the companion initialism is AHCA. Twitter was joking last night about how much trouble the addition of that measly H is causing. Other AHCAs like— this one(link is external) and this one(link is external)—are going to see more action on their Twitter feeds and clicks on their websites. Nicknames include GOPCare and Trumpcare, … Read more

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New options treatment rheumatoid arthritis

Otilimab is really a monoclonal antibody, biologic medication, which aims and also inhibits the inflammatory cytokine GM CSF. At the Colleges of Oxford and Birmingham, and supervised by the Pharmaceutical company GSK, investigators researched the clinical ramifications of otilimab to avoid inflammation, tissue pain and injury in people who have RA. The analysis assessed the … Read more

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NCQA Puts Pressure on Plans That Don’t Report HEDIS Scores

QUALITY MEASUREMENT Overall, HEDIS performance didn’t change much from 1997 to 1998. More troubling is an apparent move away from accountability. Michael D. Dalzell Senior Editor Chart: Experience makes for better scores Chart: Public reporting declines… while population representation grows Now hear this: If you’re a health plan that doesn’t participate in HEDIS, you’re one of the … Read more

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2005

January 2005 February 2005 March 2005 April 2005 May 2005 June 2005 July 2005 August 2005 September 2005 October 2005 November 2005 December 2005 Paul LendnerPaul Lendner ist ein praktizierender Experte im Bereich Gesundheit, Medizin und Fitness. Er schreibt bereits seit über 5 Jahren für das Managed Care Mag. Mit seinen Artikeln, die einen einzigartigen … Read more

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Anthem Blocked In Bid To Buy BCBS of Kansas

The consolidation of member plans in the Blue Cross and Blue Shield Association has hit yet another snag. The Kansas Supreme Court on Aug. 6 upheld an order blocking the $190 million sale of the not-for-profit Blue Cross and Blue Shield of Kansas to Anthem, a for-profit operation. In making the decision, the court cites … Read more

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D.C., Maryland Blues Plans Come Together

Insurance regulators in Maryland and the District of Columbia approved, with conditions, the merger of Blue Cross Blue Shield of Maryland and Blue Cross Blue Shield of the National Capital Area. The move creates the largest health insurer in the region. Regulators stipulated that the two plans continue to be charitable institutions and safeguard assets … Read more

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Genes tell story young doctors age too quickly

Everybody else always knew that they weren’t really invincible, and now they seem to be grasping that fact as well. More than 70% of people 30 and younger say that having health insurance is very important to them, according to a poll by the Kaiser Family Foundation (https://tinyurl.com/insured-youth). These have historically been called the “young … Read more

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What Do We Mean By ‘Patient Engagement’?

One of the buzz terms often heard in discussions of improving the health care system is “patient engagement.” But what does it mean? The definition changes, says a new analysis in the Journal of Participatory Medicine. “Despite the widespread use of the term ‘patient engagement,’ our study showed significant variations in its conceptualization, testifying that … Read more

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Congressional Anti-Kickback Battle Hinges on HCFA’s Regulatory Stance

Washington Watch In an election year, the political hot buttons — the Patients Bill of Rights and a Medicare prescription benefit, and maybe the issue of medical errors — are sure to get a lot more attention than such mundane things as laws that would address potential kickbacks. So little attention has been focused on … Read more

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Health information officers hot commodity

HIPAA regulations, icd 10 instruction requirements, electronic medical records, and quality efforts, among other matters, have put a great deal of requirements on physicians’ time. To recover concentrate on curing people, many hospitals and physicians are hiring medical scribes to assign administrative tasks. For years and years, scribes are recording crucial events such as recordkeeping. … Read more

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Docs and Insurers Work To Advance Health Literacy

Both AHIP and the AMA address ways to give better care to 75 million Americans who struggle to follow directions Frank Diamond Managing Editor Common ground is prime real estate to those trying to gather the warring factions in health care under the banner “reform.” William Butler Yeats wrote that “the center cannot hold,” and … Read more

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What if They Threw a Revolution And No Health Plans Showed Up?

United HealthCare’s move to make advance authorization “obsolete” generated headlines. Inside the industry, however, the reaction was muted. Steve Heimoff MANAGED CARE December 1999. ©1999 MediMedia USA SIZZLE OR SUBSTANCE? United HealthCare’s move to make advance authorization “obsolete” generated headlines. Inside the industry, however, the reaction was muted. Steve Heimoff When United HealthCare announced in early November … Read more

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FDA approves noctiva nasal spray for nocturnal polyuria

Approved by both the U.S. Food and Drug Administration to take care of frequent urination during the night as a result of nocturnal polyuria. Noctiva Is your first medication approved to treat nocturnal polyuria from the USA, the FDA added. Noctiva, taken approximately thirty minutes before bed, was made to raise absorption of water through … Read more

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Physicians want to fit in

How well physicians fit in with the corporate culture of provider organizations such as hospitals and group practices influences whether they’ll stay or even whether they’ll come aboard in the first place, according to a study by Cejka Search and Physician Wellness Services, a company that tries to help provider organizations run more smoothly. “When … Read more

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Payers

Commercial insurers, the employer and individual market, plus Medicare trends, Medicare Advantage, & Medicaid managed care PAYERS Large Employers Push Back on PBMs In 2020, eight companies in the National Drug Purchasing Coalition hope to change how PBMs do business. THE FUTURE OF MANAGED CARE Lab Benefit Managers Seek To Stem The Rising Tide of … Read more

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For healthy locales, think Yankee stew – not chicken-fried steak

New Hampshire snatched the honor of the healthiest state in the U.S. from Minnesota in 2000, while Mississippi regained its status as least healthy, according to a report prepared by UnitedHealth Group. The findings reflect not only absence of disease, but also social factors that can influence prevalence and risk of illness: smoking, violent crime, … Read more

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Why Market Competition Will Not Mend Our Health Care System

Doctors have a saying: ‘Half of what we know is wrong.’ In which half is the conventional wisdom that competition is society’s best hope for improving quality and controlling costs? Maggie Mahar Editor’s note: With all the talk in the industry about the virtues of the marketplace and so-called consumer-driven or consumer-directed plan designs in … Read more

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Worriedwell

The unwanted term ‘the nervous’ will be used, especially by policy makers now by some clinicians too. Ordinarily, it refers to a set of patients that are regarded as with medical services inappropriately or , when other deserving patients ought to receive care. It thus reflects the older notion of this deserving and undeserving poor, … Read more

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Index of /archiveMC/9711

Name Last modified Size Description Parent Directory 26-Jul-2000 21:05 – ../../../../archiveMC/9711/9711.addyears_large.gif 17-May-2000 12:17 17k ../../../../archiveMC/9711/9711.addyears_small.gif 17-May-2000 12:17 11k 9711.amap.shtml 17-May-2000 12:17 8k 9711.capitation_part..> 17-May-2000 12:17 19k 9711.capitation_part..> 17-May-2000 12:18 17k 9711.capitation_part..> 17-May-2000 12:18 8k 9711.compass.map.gif 17-May-2000 12:18 15k 9711.compass.nationa..> 17-May-2000 12:18 15k ../../../../archiveMC/9711/9711.compass.pdf 17-May-2000 12:19 155k 9711.compass.regions..> 17-May-2000 12:19 28k 9711.compass.reportc..> 17-May-2000 12:19 30k 9711.compass.shtml … Read more

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Drug pipeline loses pressure

When fluids flow through plumbing, energy declines necessarily happen. On the 1 hand, that is a result of friction which develops between the pipe and the fluid. On the flip side, side effects also occur over the fluid on account of this viscosity of their fluid. The faster the more fluid escapes, the more the … Read more

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transparency

The Nuka Way One of the four 2011 Malcolm Baldridge National Quality Award winners in health care is Southcentral Foundation, a nonprofit organization established in 1982 to serve Alaska Natives who live in and around Anchorage. The Southcentral Foundation (SCF) describes itself as a Nuka system of care — Nuka being an Alaska native name … Read more

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The Epilepsy Battle in the War Between Brands and Generics

Brand-name manufacturers and many neurologists see danger in generic substitution, but the FDA insists that the practice is safe In the war between brand-name drug companies and generics manufacturers, each side is almost religious in its orthodoxy and intransigence. The ground they fight over is the patient. On one side are the large pharmaceutical companies, … Read more

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Doctors say they’re busy but underpaid

Back in the heyday of managed care, primary care physicians were poised to occupy the central role in health care delivery. Over the last half-decade, that has changed. A survey by Merritt, Hawkins, & Associates, a search-and-consulting company, suggests that physicians consider themselves to be busy but poorly paid, although maybe everyone who collects a … Read more

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HMO Liability Battleground Moving to Courts, Statehouse

MANAGED CARE November 1999. ©1999 MediMedia USA RIGHT TO SUE The adage “all politics is local” may, in the end, become the motto that sinks ERISA. HMO executives should assume protection will evaporate. Allen Briskin Gerry Hinkley In the coming months, a House-Senate committee will debate whether the next Patients Bill of Rights should give health plan … Read more

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Financial stability HMOs called mixed bag

Patients with acute myelogenous leukemia (AML) whose disease had relapsed or was resistant to chemotherapy and those who were unable to tolerate chemotherapy have shown clinical responses to venetoclax (Venclexta, AbbVie/Genentech), with complete remissions in some, according to new phase 2 data published in Cancer Discovery. Venetoclax is a small-molecule B-cell lymphoma 2 (BCL-2) homology 3 … Read more

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Medicare Formulary Model Seen by Many as Too Inclusive

MANAGED CARE November 2004. ©MediMedia USA The issue is how extensive the list of covered medications should be for the new Medicare pharmaceutical benefit. The stakes are enormous. John Carroll The United States Pharmacopeia isn’t what you’d consider a controversial organization. But when Congress selected USP to develop a model drug formulary that could be adopted by … Read more

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Wearing Black Hats … Again

Simplistic, for sure. But a movie pitting a man with modest income against the big bad managed care plan has drawn attention to the enormous cost of transplants and the difficulty of matching organs and recipients. Also available in PDF Managed care is known to have a poor image in the popular media, although it … Read more

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Stark II wants contribution plan installed before payment period begins

The author reviews a number of their newest doctor self-referral (Star K ) rule’s primary implications for medical set reparation plans. In Stage II of the Stark law, the Centers for Medicare & Medicaid Services described certain provisions and others maybe not coped with in Stage I. The fluctuations have major, broadly speaking positive consequences … Read more

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Health Plans That Decredential Docs Must Do It Correctly and Expect a Fight

Last month, we advised physicians not to allow themselves to be decredentialed without putting up a fight. This month, we advise managed care organizations that, well, physicians are going to fight decredentialing — and as a result, MCOs should approach this process very carefully. There are many forces at work resulting in increased scrutiny of … Read more

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PBMs: Maligned as Middlemen, They’re Hearing Wedding Bells

The industry has been criticized for lack of transparency—and worse. Some see ‘a ton of sense’ in the proposed mergers with insurers and retailers. Others see a risk of even higher drug prices and a need for oversight. Three years ago people in health care circles were congratulating Express Scripts for negotiating a significant discount … Read more

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The Mountain Named JCAHO Meets the Tremor Called ISO

Proponents say ISO 9000 standards are a less prescriptive, ponderous and costly way to review hospitals. But are they truly applicable to health care? Proponents say ISO 9000 standards are a less prescriptive, ponderous and costly way to review hospitals. But are they truly applicable to health care? Nothing sets off shock waves within a … Read more

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FDA Says “No” to Hyperkalemia Drug

Manufacturing issues sink ZS-9 application The FDA has issued a complete response letter (CRL) regarding the new drug application for ZS-9 (sodium zirconium cyclosilicate, ZS Pharma/AstraZeneca), an investigational medication being developed for the treatment of patients with hyperkalemia. The CRL refers to observations arising from a pre-approval manufacturing inspection. The FDA also acknowledged the receipt … Read more

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New Insight Into Course and Transmission of Zika Infection

Though first Recorded 70 Years Back, That the Zika virus Had Been Badly Known as it burst on the scene at the Americas at 2015. In just one of those earliest and largest studies of its own kind, a study team directed by virologists in Beth Israel Deaconess Medical Center has distinguished that the development … Read more

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Wellness program gets job training

Employers “plan to sharply increase the incentive amount for maintaining a healthy lifestyle or participating in a wellness program,” according to a survey by the National Business Group on Health. Companies know full well that the Affordable Care Act changes the minimum amount an employer can deduct from premiums under HIPAA from 20 to 30 … Read more

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Study: Extended-Release Naltrexone for Opioid Addiction Reduces Risk of Relapse

Vivitrol is only medication labeled for relapse prevention In a multicenter, randomized clinical trial, former prisoners who received six monthly injections of extended-release naltrexone (Vivitrol, Alkermes, Inc.)––a medication that blocks opioid receptors in the brain––were significantly less likely to resume opioid use than were those who received counseling and referrals to community treatment centers without … Read more

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Community-Based Research: Not Just for Pharmaceuticals

By John La Puma, M.D. Practice-based research has a long and honorable history. Well before there was an NIH or an IRB, there were practicing community physicians making observations. For example, in our own practice, more patients than ever are overweight or obese. Neither diet pills nor conventional weight loss programs seem to help for … Read more

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A Conversation With F. Randy Vogenberg, PhD, RPh: Changing Market for Pharmacy Benefits

Tight budgets and an increasing influx of expensive biologic drugs make it imperative to rethink risk management John Marcille At a time when health care reform is uncertain and hard-to-categorize biological drugs are becoming a greater share of overall costs, health plan medical and pharmacy directors have the opportunity to help reinvent how health care … Read more

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Humana Thinks Premium Cap Sets Plan Apart

Humana hopes to gain a competitive edge by joining two important components of today’s insurance — consumer-directed health plans and information technology — with a rare cap on premium hikes. The health plan launched SmartAssurance on June 2, capping rate increases at 9.9 percent in the second year for customers enrolled in SmartSuite, a consumer-directed … Read more

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Attacks Prompt Examination of Mental Health Care Funding

With Congress debating renewal of the Mental Health Parity Act, it can be argued that Sept. 11 added urgency to expanding access to behavioral services. Madeleine A. Estabrook Sidebar: Counseling in the aftermath of terror As a nation, we are dealing with enormous emotional trauma from the events of Sept. 11, 2001, and anxiety over what … Read more

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Stephen Hahn Hearing Set for Nov. 20

No red flags yet on nomination of MD Anderson doc for top job at the FDA Stephen Hahn, MD, nominated to become the next FDA commissioner, has won the backing of the chair of the Senate health committee and is scheduled to appear before the committee on Nov. 20. “As an oncologist, Dr. Hahn knows … Read more

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Index of /archives/0001

Name Last modified Size Description Parent Directory – ../../archives/0001/0001.compmon.gif 01-Jan-2000 12:00 39K 0001.compmon.html 13-Jul-2007 12:20 1.6K ../../archives/0001/0001.compmon.pdf 01-Jan-2000 12:00 42K 0001.contents.html 16-Jul-2007 08:25 3.2K ../../archives/0001/0001.cover.jpg 01-Jan-2000 12:00 9.7K 0001.dmpac.chartpac…> 01-Jan-2000 12:00 12K 0001.dmpac.chartpac…> 01-Jan-2000 12:00 15K 0001.dmpac.chartpac…> 01-Jan-2000 12:00 15K 0001.dmpac.chartpac…> 01-Jan-2000 12:00 16K 0001.dmpac.chartpac…> 01-Jan-2000 12:00 8.1K 0001.dmpac.chartpac…> 01-Jan-2000 12:00 7.4K 0001.dmpac.chartpac…> 13-Jul-2007 12:20 … Read more

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How to Contact Us

Send editorial inquiries and questions to: Peter Wehrwein, Editor (link is external) To respond to an article for possible inclusion in the “Letters to the Editor” column, write to: Editors (link is external) Advertising inquiries, including media kit requests: Maureen Dwyer Liberti, Publisher (link is external) Production, including advertising deadlines and materials Dawn Flook (link … Read more

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Herzlinger Predicts ACOs, PCMHs Will Fail

Accountable care organizations and patient-centered medical homes are unlikely to succeed. Those are two predictions from Regina E. Herzlinger, a professor at the Harvard Business School who has successfully predicted some of the most powerful trends in health care since the 1990s. Arguably, most of her predictions about health care have come true or are … Read more

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Bob Kocher Believes (With Missionary Zeal) That Venture Capital Can Start To Cure What Ails American Health Care

Whatever happens to the ACA, says this upbeat doctor-policymaker-entrepreneur, it was only the beginning of health care’s transformation. But will this version of better health care mean pink slips? New health care ventures to spend money on? That would seem the last thing the U.S. economy needs. We’re far and away the world’s champion health … Read more

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U.S. Supreme Court To Hear Suit Against HMOs Over Incentives

MANAGED CARE November 1999. ©1999 MediMedia USA Can HMOs be sued for the practice of offering bonuses to physicians who help them keep the cost of care down? That’s a question the U.S. Supreme Court has agreed to decide this term, in the first major case involving HMO liability to reach the high court.involving HMO liability to … Read more

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MSAs Fall Short Of Expectations, Says GAO Report

If medical savings accounts were a stock, they’d be falling –if not plummeting. But if they were a stock, they just might be a good buy right now. According to a General Accounting Office survey, more than three-quarters of MSA vendors say that sales of qualified plans were lower than expected. But most experts expect … Read more

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When it comes repeal and replace americans are divided and still making their

GOP lawmakers rarely cite Obamacare, and also a GOP-backed challenge into regulations at the Supreme Court does not seem to become a significant threat. Along with long-favored Republican layouts on decreasing the healthcare safety net isn’t terrific politics or policy at the center of a pandemic and financial catastrophe. Which leaves a Enormous fat question … Read more

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Show Me The Outcomes!

Valid outcomes studies in disease management are elusive. Which are good? Which are not? How do you evaluate what a vendor has to offer? Out·come (out´·kum), n. 1. A final product or end result; consequence. 2. A conclusion reached through a process of logical thinking. (Random House Unabridged Dictionary of the English Language, second edition, … Read more

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Most hospitals fail to meet Leapfrog’s surgery volume standards

Ost hospitals don’t fit with the Leap Frog Group’s minimum volume requirements for eight speculative procedures, as found by your report published Thursday by the organization.To choose the eight approaches, leap-frog examined countless studies Conducted at the previous ten decades and looked over guidance from Leap Frog’s National Inpatient Surgery Expert Panel. No medication without … Read more

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January 2003

Digitally, the VA Leads the Way For the past 20 years, the VA has labored at one of the most advanced electronic medical records in the country – and is giving the technology away. Private vendors object that it relies on outdated software. Quality Counts: So Why Not Offer Physicians Bonuses? Plans will have to … Read more

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Headlines On Deadline…

Total HMO enrollment grew 6.1 percent, to 76.7 million, during the last six months of 1997, according to InterStudy, which tracks HMO trends…. Enrollment in PPOs is soaring. The American Association of Health Plans says PPOs have added 44 million members in the last five years, while HMOs have attracted 30 million…. How many doctors … Read more

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HIPAA Privacy Rules Create Uncertainty, Compliance Woes

When it comes to information-sharing, just when does ‘no’ mean ‘no’? What about conflicting statutes? We have two years to sort it out. The privacy requirements mandated by the Health Insurance Portability and Accountability Act of 1996 are finally out. For health plans and providers, the hard work is just beginning: figuring out how to … Read more

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Headlines On Deadline …

NEWS AND COMMENTARY Members of Blue Cross and Blue Shield companies and privately-held health plans tend to rate their overall service experience notably higher than enrollees of non-Blue plans owned by publicly-traded companies, says new study by J.D. Power and Associates. The study asked 10,522 members of large commercial health plans to rank the performance … Read more

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cdc looks back significant contributions fight against zika 2016

Seventy years Later CDC was Set to fight mosquitoes Which Transported Malaria, CDC found itself in combat with yet another mosquito-borne disease, Zika virus. As the catastrophe response tactics one particular year, CDC’s Morbidity and Mortality Weekly Report highlights 10 critical donations towards the fight Zika virus this past year. “Struggling Zika is the most … Read more

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Briefly Noted

Improving physician behavior probably ranks somewhat lower on hospital priority lists these days than getting ready to avoid penalties for early readmissions, which are mandated by the Affordable Care Act. A study by IMA Consulting says that many hospitals are still not prepared to deal with this. The study cites the Centers for Medicare & … Read more

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Banks Give Insurers an Offer Most of Them Cannot Refuse

Managing the assets of a health savings account has banks excited, but leaving charges in the hands of members makes providers nervous John Carroll Contributing Editor Beginning in April, some of the patients arriving at Tenet’s hospitals in Texas had a brand new way to pay their bills. Companies with self-funded or self-insured health plans … Read more

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Eribulin mesylate halaven succeeds late stage liposarcoma trial

Halaven is a injectable chemotherapy Medication Developed by Eisai for its treatment of unresectable or metastatic liposarcoma patients who previously received anthracycline-based Chemo Therapy. Eisai filed the brand new drug program for Halaven for its Treatment of liposarcoma into the US Food and Drug Administration,” Europe Commission and also Japan at July 2015. It submitted … Read more

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The Aftermath: What Will the Trump Presidency Mean for the ACA, Drug Prices

The ACA started to figure in the waning days of the campaign as Trump and the Republicans used the 25% ACA premium hikes to bash the signature domestic achievement of the Democrats and President Obama. There’s a lot of undoing on Trump’s to-do list (NAFTA, climate change agreements), but he may have some political willpower to follow … Read more

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AUGUST 2018

Managing care in the 21st century PETER WEHRWEIN Our inaugural innovation issue! Ah, look at all the lonely people (and resultant health problems thereof) FRANK DIAMOND Deal with people’s isolation and disconnection to head off physical health problems—and possibly health care costs. Shelter from the health care storm LOLA BUTCHER Provide housing for people experiencing … Read more

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New Drugs Continue to Lack Info P&T Committees Need

When many randomized trials are badly done or irrelevant, what are formulary managers and committees to do? Ed Silverman Sean Karbowicz, PharmD, has some sobering news for anyone who designs clinical trials: Most of them really aren’t very useful for the managed care organizations that make coverage decisions. Too often, he contends, the studies contain … Read more

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Blogs

ACOs Produce Good Cost and Quality Results Maybe, just maybe, accountable care organizations (ACOs) are the best bet for hitting the health care exacta of controlling costs and improving the quality of care. Figures released by CMS on September 16 showed that the 23 organizations in the elite Pioneer program and 220 in the Shared Savings program … Read more

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Fearful After Enactment of ACA, Brokers Find New Opportunities

LEGISLATION & REGULATION Fearful After Enactment of ACA, Brokers Find New Opportunities The Affordable Care Act had brokers thinking they would lose business. Now they are working with private exchanges and adapting in other ways. Longtime Chicago health insurance broker Tim Elenz watched his market undergo a sea change with the passage of the Affordable … Read more

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Most People Happy With Their Coverage

The adage that while most Americans take a dim view of Congress as an organization, they rather like their own congressman took a beating last November. Still,there is a reason that such statements are called truisms. Americans still appear satisfied with their health care coverage, according to a Wall Street Journal/Harris Interactive poll. This particular … Read more

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MCOs, drug manufacturers have lots of PR work to do

Since 1997, Harris Interactive has asked the public to rank various industries by whether it feels they’re doing a good job in serving customers. The latest results, from a telephone survey of 979 adults taken between April 8 and 15, includes some disheartening numbers for both managed care companies and pharmaceutical manufacturers, but especially pharmaceutical … Read more

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Inflation could spark higher health care costs

The news that national health expenditures rose a modest 4.4 percent in 1996 is not likely to be repeated, according to a new estimate by Milliman & Robertson. Though M&R does not foresee an immediate return to the days of double-digit increases, its 1997 — 2000 health spending forecast predicts a moderate rise, due mostly … Read more

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Repatha Demonstrates Reduced Need For Apheresis In Patients With High LDL Cholesterol In Phase 3 Study

Amgen Now announced positive Top Line results in the Phase 3 Analysis evaluating Repatha® In patients that have been receiving apheresis to cut back low density lipoprotein cholesteron. The study met its primary end point, demonstrating the treatment with Repatha somewhat reduced the demand for ldlc apheresis in mature patients, as measured in the ending … Read more

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Ex-Prisoners In Need of Care

Ex-Prisoners In Need of Care There’s a gap in the proverbial health care safety net that’s big enough for a whale to swim through. People who are incarcerated, on probation, or on parole — what a recent study calls the “justice-involved population” — make up 22% of the 13 million newly eligible people. “The justice-involved … Read more

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Survey finds cannabis use epilepsy

The curiosity about cannabis-based services and products to treating refractory epilepsy has sky rocketed in the past couple of decades. Pot and other cannabis products using high material at – tetrahydrocannabinol, used mainly for recreational purposes, are normally unsuitable for this particular sign, chiefly since THC is correlated with numerous unwanted side effects. In comparison … Read more

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Molecular Diagnostic Testing Presents $5 Billion Conundrum

Insurers know that the new tests can be valuable, but have trouble evaluating them and may not even know exactly which ones they are paying for While much has been written about the promise of new molecular and genetic diagnostic tests, they also bring a tidal wave of complexity, cost, and quality issues for health … Read more

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Your Disability Insurance: More Costly, More Needed

By Marsha Bertrand We all know we’ll eventually face death, but most of us never consider the possibility of becoming disabled. Statistics show, however, that the probability of long-term disability during a person’s working years is double the probability of death during the same period. Of those who are disabled, one in three will be … Read more

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Readmissions Drop 47% at Texas Hospital As Patients Self-Administer IV Antibiotics

Program helps uninsured patients Parkland Hospital, an 800-bed safety-net facility serving Dallas County, Texas, is teaching uninsured patients how to self-administer intravenous (IV) antibiotics for outpatient parenteral antimicrobial therapy (OPAT), and the innovative approach appears to be paying off. The program lowered 30-day readmission rates by 47% over a four-year period, according to a study … Read more

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Star cancer drug tecentriq flops late stage trial

The FDA has given the green light to atezolizumab (Tecentriq, Genentech) for the treatment of patients with urothelial carcinoma, the most common type of bladder cancer. Atezolizumab is the first product in its class (programmed death-1/programmed death ligand-1 [PD-1/PD-L1] inhibitors) approved to treat this type of cancer. Atezolizumab targets the PD-1/PD-L1 pathway (proteins found in … Read more

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Regimen change gilead’s taf drugs toppling tdfs HIV treatment

Costly protease inhibitors work well in many patients, but call for careful monitoring In less than a year, two new protease inhibitors — telaprevir (Incivek) and boceprevir (Victrelis) — have changed the standard of care for hepatitis C by introducing a new mechanism of action, but their significance goes beyond that. They are the first … Read more

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Republicans Relent On Mental Health Parity

Suddenly realizing their curmudgeonly ways weren’t wowing the electorate, the Republicans voted an 11th-hour endorsement of mental health parity, forbidding insurance companies to cap such coverage at a lower level than that for medical or surgical services. Effective Jan. 1, 1998, health plans will have to abandon the practice of limiting treatment of mental disorders … Read more

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Would Healthy People 2000 Record Have Been Worse Without HMOS?

A major assessment of Americans’ health is mixed. What role has managed care played in the nation reaching — or not reaching — key health goals? We’ve only fully met about 15 percent of the objectives set out in the Healthy People 2000 program, which Washington developed in 1979 as a blueprint for federal and … Read more

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Biosimilar market in the United States to grow slowly, Milliman says

Milliman predicts that it will be at least 12 years before biosimilars fully penetrate the market in the United States. But the consulting company tells employers that the U.S. market could possibly evolve the same way that it has in Europe, where biosimilars have a healthy presence. Milliman recently updated its 2011 study—“Understanding Biosimilars and … Read more

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Viagra Takes Market by Storm; Who Pays is Another Matter

NEWS AND COMMENTARY With one Connecticut physician calling it “the biggest thing since the Beatles,” Viagra, Pfizer’s popular pill for impotence, has burst onto the scene like few others. Its popularity seems to have caught insurers off guard as they scramble to develop a yardstick for coverage. According to IMS America, which tracks pharmaceutical trends, … Read more

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June 1999

Diverse Populations Offer Plans Chance To Do Good — and Well Minority groups offer a large untapped market right within our national borders. Health plans and physicians need to develop the tools to serve it. PPOs: A Better Brand of Managed Care? With PPO enrollment nearing 100 million, HMOs are getting a healthy dose of competition. … Read more

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pt digest dry eye syndrome

Within our past edition of this EYE eat up we moved over outward symptoms and causes of dry eye disease and touched on treatment choices. Still another remedy revolves round diminishing or eliminating potential ecological instigators of dry eye disease. Dusty surroundings, for example sawdust or sand loaded surroundings are timeless places which result in … Read more

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Several HMOs Stung in N.Y. Test Of Consumer Law

More than half of 31 HMOs in New York state failed to properly respond to telephone requests for information they are legally required to provide, according to Attorney General Dennis Vacco. The state’s Managed Care Consumer Bill of Rights, enacted last year, includes a requirement that plans provide subscriber contracts and member handbooks upon request. … Read more

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Less Pain, Lower Costs: Can Integrative Medicine Do Both?

Employers believe in this hybrid approach. Is it time for medical insurers to look at it carefully? Combining state-of-the-art mainstream medicine with a range of less-traditional but evidence-based therapies is becoming an accepted, cost-effective option for improving patients’ health. The blended approach is referred to as integrative medicine. Increasingly, integrative techniques that have been validated … Read more

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Pharma sales reps enlisted war opioid addiction

The War on drugs. What started as a struggle Basing on morals has in reality generated multiple general health disasters, without a recent occurrence exemplifies this in more gruesome detail compared to America’s opioid tragedy. With this particular tide of mortalities came an uncontrollable tidal wreck of parens patriae suits filed by counties, states, and … Read more

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Mental Health Parity: At Long Last?

A coalition of employers, legislators, consumer advocates, health plans, and drug companies may bring about equal coverage The health care industry and the American people may be at a historic moment in the treatment of mental health and substance abuse. Congress is considering legislation that would “completely end insurance discrimination against mental health and substance … Read more

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For physician executives, that M.B.A. really pays off

As the worlds of business and medicine become more intertwined, physicians who pursue advanced degrees in business are rewarded financially. Among members of the American College of Physician Executives surveyed by Cejka & Co., a St. Louis-based consulting and search organization, median incomes for doctors with business-oriented master’s degrees were higher than those of physicians … Read more

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Health Plans Won’t Sit Out While Docs, Hospitals Dance

As providers scramble to form accountable care organizations, insurers take steps to either participate, or limit ACO market power Thomas Reinke Contributing Editor Hospitals, physicians, and insurers suddenly find themselves in a furious round of corporate speed-dating as these major stakeholders explore realignments and forge new alliances in the face of health care reform. The … Read more

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NCQA Reviewing Comments About Its DM Standards

Surveys will begin in January for disease management organizations seeking the National Committee for Quality Assurance’s seal of approval. NCQA took public comment on its DM standards until July 31. Accreditation is offered to entities that pass a review of six areas: program content, clinical systems, coordination of care, patient self-management, practitioner support, and clinical … Read more

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Could a Wal-Mart PBM Succeed?

The company can be expected to be as tough in the PBM arena as in retail, but it has a few hurdles to overcome When Wal-Mart tackles a new market, it has enough brawn to bend prices for every player in the game. The retail leviathan’s low-price generic drug program — announced less than two … Read more

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Cultural Sensitivity Is Vital In Medication Management

The diverse Latino population requires insurers to understand that there is no cookie-cutter answer for successful medication management Martin Sipkoff Diabetes and other chronic diseases disproportionately affect the 15 percent of our population that is Latino. Because health plans play an important role in encouraging patient medication management, several national and regional plans are developing … Read more

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21 Sign up for Next Generation Program

Robert Calandra The Next Generation ACO program has gotten off the ground with 21 organizations agreeing to participate this year. That’s a solid start for a program that was expected to have between 15 and 20 provider organizations during it’s first two years. Chris Dawe “This level of participation shows that CMS is listening to the … Read more

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New Provider Coalition Attacks OIG’s Ruling Barring ‘Gainsharing’

Last July, the Office of the Inspector General of the Department of Health and Human Services issued a ruling that many gainsharing programs between hospitals and physicians were illegal. Hospitals and physician groups were outraged, and they vowed not to take it. Now they’re trying to do something about it. And it all involves just … Read more

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Hospital profit margins grow while length of stay decreases

While managed care has helped reduce the average length of stay in hospitals, it doesn’t seem to have affected hospital profit margins — at least until very recently. In fact, those margins rose between 1993 and 1997 as the average length of hospital stay dropped. Meanwhile, HMO profit margins dropped. SOURCE: KAISER FAMILY FOUNDATION ANALYSIS … Read more

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The Pursuit of Happy Docs

Some health plans do a better job than others in bolstering physician satisfaction. Systems really matter. Frank Diamond It turns out that the National Committee for Quality Assurance, the Commonwealth Fund, Kaiser Family Foundation, America’s Health Insurance Plans, and the American Medical Association do not actually pinpoint particular health insurers that are the apples of … Read more

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Health Insurers Struggle to Manage Number, Cost of Genetic Tests

Information overload from a flood of new diagnostics forces insurers to ramp up prior authorization and utilization review. They say there are no stupid questions. But what about the questions that surprise us because they were asked? For several years, Michael Laposata, MD, chairman of the Department of Pathology at the University of Texas Medical … Read more

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Physician education and intervention reduces antibiotic prescriptions

Plans have to be developed to boost antibiotic-prescribing. Our objective is to examine of educational programs targeted toward improving antibiotic-prescribing by doctors or antibiotic-dispensing from pharmacists, in both Primarycare and hospital settings. We found 78 studies for investigation, 4-7 at Primarycare and 3 1 in hospital settings. The studies differed widely InDesign but mostly reported … Read more

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Health Expenditures Ease a Bit; Drugs Lead Cost-of-Care Increase

Thanks to lower-than-anticipated spending for Medicare, national health expenses will grow more slowly in the coming decade than previously thought. Still, the nation’s health care bill is expected to double to nearly $2.2 trillion by 2008.$2.2 trillion by 2008. The Health Care Financing Administration predicts that Medicare spending will rise only 4.5 percent from 1997 … Read more

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Abramovitz

20thcentury economics, expired on Dec. 1 in Stanford University Hospital in an illness, just 1 month before his 89th birthday. Throughout his livelihood Abramovitz left Numerous initiating empirical contributions to the analysis of macro economic changes and longterm financial growth. These accomplishments included measuring changes in stocks in production businesses and their function at the … Read more

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Study: Warfarin Genotyping Reduces Hospitalization Rates

MANAGED CARE April 2010. ©MediMedia USA Twenty-two percent of patients who start taking warfarin, a commonly prescribed blood thinner, end up in the hospital within six months, according to health plan data compiled by Medco Health Solutions. That’s because it is exceptionally difficult to administer the proper dose, owing to great genetic variation among patients. A study … Read more

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Mental Health Parity Just Around the Corner?

John Marcille Don’t believe it until you see it. Our cover story on mental health parity by Contributing Editor Martin Sipkoff reports that we are at a turning point. The focus is mainly on what legislators will do, but Washington, D.C., is famous for good ideas that never became law. As Martin notes, there’s a House version … Read more

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MedPAC Proposals Echo Private Payers’ Own Concerns

The Medicare Payment Advisory Commission is asking Congress to promote primary care and to hold providers accountable As health insurers search for ways to address unsustainable cost increases, an influential government commission is urging Medicare to step into the lead. The Medicare Payment Advisory Commission, which advises Congress regarding the Medicare program, recommends reorganizing the … Read more

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Calling Something an ACO Does Not Really Make It So

Many who claim to be constructing such entities are really creating ‘clinically integrated organizations’ Organizations that are not aligned with the definition of an ACO can be more accurately described as clinically integrated organizations (CIOs). The major difference between the two is that true ACOs, by definition, are Medicare fee-for-service (FFS) entities only. HMOs compared … Read more

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Analyst: Pharmacists have nothing to complain about

The National Community Pharmacists Association (NCPA) asserts that “pharmacists are underappreciated, judging by the design of many public and private sector prescription drug plans” (http://tinyurl.com/Dose-blog). Adam J. Fein, PhD, author of the Drug Channels blog (http://tinyurl.com/Fein-blog), begs to differ. “Are pharmacists undervalued?” he asks. “Not if money equals appreciation.” Fein, president of Pembroke Consulting, analyzed … Read more

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Injectable Drug Program Saves Plan $28.5 Million

A health plan saved $28.5 million by separating the service physicians perform in administering medical injectable drugs (MIDs) from the cost of the drugs themselves. Highmark, a licensee of the Blue Cross & Blue Shield Association, paid for the drugs and the doctors’ time and skill through the medical benefit. Historically, the plan used a … Read more

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Providers health care trenches use design thinking spur innovation

Applying Layout Assuming to medical care may enhance innovation, efficacy, and efficacy by boosting attention on provider and patient requirements. The target of this inspection is to establish the best way Design Thinking hasbeen utilized in healthcare and whether it’s beneficial. We Data were accumulated to target end users, medical states, intervention, Layout Thinking approach, … Read more

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Employer-based coverage makes gains, while gaining confidence of Americans

The percentage of Americans under age 65 with employer-sponsored health coverage grew slightly from 63.5 in 1993 to 64.9 in 1998, following five years of erosion. A report by the Employee Benefit Research Institute attributes the gain to a smaller pool of self-employed workers and an increase in the number of people working for large … Read more

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STATE INITIATIVES

Off-label provisions spread Color chart Twenty-eight states mandate some form of insurance coverage for off-label pharmaceutical use, and the trend is accelerating. In 1997, 11 states implemented off-label coverage provisions. Such laws typically forbid coverage denials based on grounds that an indication has not been approved by the Food and Drug Administration. Paul LendnerPaul Lendner … Read more

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New Era of Health Care Spending Could Roll Into the Good Times

The slowdown in increases often happens during and shortly after recessions, but this time the trend may continue as the American economy perks up About a decade ago, economists noticed something strange about the rate at which health care spending increased: the relentless climb started to level off. Then came the economic slowdown of 2007—some … Read more

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Docs unconvinced about P4P effectiveness

In a recent survey, primary care physicians (family practitioners, internists, and pediatricians) were asked about their attitude toward pay for performance (P4P), in which physicians are financially rewarded for achieving positive outcomes and high patient satisfaction scores. Only 7.3 percent endorsed the concept fully, while 40.6 percent indicated it is “a good idea but data … Read more

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Physician, help thyself: management positions available

Employed as a certified professional adviser has its own downs and ups, specially once you face problems very similar to those of one’s clientele. I have endured social stress for a massive portion of my own life. I remember days at middle school and higher school once I stressed myself sick, remained home, neglected to … Read more

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FDA, Gottlieb Get Real About Real-world Evidence

Implementation of a new framework would secure RWE’s role in the drug-approval process. When Roche last year launched its bid to acquire Flatiron Health and its treasure trove of oncology electronic health record data, Daniel O’Day, then CEO of Roche’s pharmaceutical business (and now in the top job at Gilead), said: “We believe that regulatory-grade, … Read more

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Decreasing Medical Costs: How Insurers Are Taking the Easy Way Out

In May 1999, Abigail Sulerzyski was born deaf and blind with cerebral palsy and multiple other medical complications. While Victoria, her mother, was learning how to cope with the needs of a severely disabled child, she was also learning how to fight with UnitedHealthcare. Abigail required continuous feeding through a jejunostomy tube, and the insurer … Read more

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Immunotherapies Can’t Keep Market Forces at Arm’s Length

TOMORROW’S MEDICINE Breakthrough drugs for fighting cancer race toward approval, but the ubiquitous question persists: How can we afford them? Few of us think about the fact that billions of our cells die each day. They die because they are “old” and need to be refreshed (red blood cells), are not needed, or are a … Read more

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Retirement looks less golden for many

Employer-sponsored health benefits for retirees could go the way of house calls and dial phones thanks to increasing health care costs. A study by the Kaiser Family Foundation and Hewitt Associates says that 10 percent of 408 companies with 1,000 employees or more plan to drop coverage for future retirees. Twenty percent say they plan … Read more

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Impact of New Texas HMO Liability Law Depends on How Congress Treats ERISA

Starting Sept. 1, Texans will be able to file medical malpractice lawsuits against HMOs, health insurers and other managed care plans. Texas’s law, the first of its kind, holds managed care organizations proportionately liable for harm caused to patients by their negligent decisions delaying or denying needed medical care. The effect of the new law, … Read more

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Direct Contracting By Physicians: How Big A Competitive Threat?

BY ANNE BILODEAU Contributing Editor It’s not a new idea, the notion that doctors can improve their autonomy, clout and profit margins by circumventing HMOs to contract with employer groups themselves. But in 1996 the concept has taken on a new urgency, as two Midwest employer coalitions have announced new direct contracting initiatives, and doctors’ … Read more

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Vol. 8, No. 2 February 1999

Legislative Onslaught May Force Conversion to Universal System Every politician seems to have a plan to reform health care. One expert says that all the attention invites trouble. COVER STORY Health Care Report Cards: Who’s Paying Attention? Health care report cards seem to be everywhere — except in the hands of smaller employers when they … Read more

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Health savings accounts keeping costs down

Health savings accounts (HSAs) not only do a better job of making workers aware of costs than do health reimbursement arrangements (HRAs), but they also drive more employees into wellness programs, according to a survey by the Employee Benefit Research Institute and Greenwald & Associates. Although the two accounts are similar, the differences between HSAs … Read more

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New Generation of Issues Now Coming to Forefront

John La Puma, M.D. Five years ago, Managed Care published my first ethics column, and became the first medical publication to recognize that medical ethics was a needed, missing part of managed medical care. Dozens of conferences, hundreds of articles, and millions of hallway discussions later, managed care ethics is part of daily medical life. … Read more

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Give them what they want

Restricted Maintenance is an interest for that we have an enormous passion and that I apologize in advance for almost any biases I’ll bring into the table, because I believe that handled medical care is a outstanding vehicle for its delivery of care to exposed people in the event medical plans are put up precisely. … Read more

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Most physicians flourish under capitation, despite declining commercial payments

Capitation rates are falling, but physicians are nonetheless profiting under capitation. Data released by newsletter publisher National Health Information indicate that despite an overall decline in average per-member, per-month payments in the last year, most physicians report higher profits from commercial capitation contracts. Paul LendnerPaul Lendner ist ein praktizierender Experte im Bereich Gesundheit, Medizin und … Read more

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Health Committee Leadership Remains Much the Same–With a Key Exception

As the 105th Congress gathers this month, one face familiar to the health care community will be missing: Republican Sen. Nancy Kassebaum of Kansas, former chairman of the Labor and Human Resources Committee. A much-heard and respected voice in the debates on managed care and health insurance, she will be replaced by James Jeffords of … Read more

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Soaring Price of Cancer Drugs Leads Plans To New Approaches

Insurers are trying different methods, from pay for performance to promoting preventive care, to hold down cost of chemotherapy drugs Martin Sipkoff The cost of cancer drugs is skyrocketing, placing a significant burden on health plans. According to Morgan Stanley, cancer drugs accounted for 13 percent of drug expenditures in 2002. This year it will … Read more

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NPs & PAs — top hiring priority for medical groups

MANAGED CARE OUTLOOK NPs & PAs — top hiring priority for medical groups Teamwork will be the goal of care delivery systems in the near future, according to a survey of physician groups conducted by Cejka Search and the American Group Medical Association. The success of accountable care organizations (ACOs) and patient-centered medical homes (PCMHs) … Read more

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Use of attention-deficit medications surges 369 percent in children under 5

A recent drug trend report issued by Medco Health Solutions paints a surprising picture of how difficult it is to get little Johnny to sit still in class or concentrate long enough to tie his shoes. The report, reviewing utilization and drug costs, describes a startling disparity between antibiotics, asthma, allergy, and behavioral medications. Spending … Read more

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Blue Cross and Blue Shield of Ohio, Selling to Columbia/HCA, Loses Name

AU.S. District Court judge has ordered Blue Cross and Blue Shield of Ohio to relinquish its trademarks–including its name. The health insurer, as one might expect, has filed an appeal. The national Blue Cross and Blue Shield Association sent the Cleveland-based company a letter saying that the plan’s license has expired and that, in any … Read more

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Costs slow down, but not enough to assuage employers’ concern

Yet one more survey shows that health care costs for companies are increasing more slowly than in recent years. This one comes from Deloitte Consulting, which surveyed 316 employers representing about 2.5 million workers. Compared to the prior year, how did health care costs change for your organization this year? Source: 2005 Consumer-Driven Health Care … Read more

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FDA panel recommends approval etanercept enbrel biosimilar

In favor of advocating the approval of GP2015, Sandoz’s planned biosimilar into Amgen’s Enbrel. Biosimilar to address rheumatoid arthritis, polyarticular juvenile rheumatoid arthritis in patients aged two decades or older, rheumatoid arthritis, ankylosing spondylitis and plaque psoriasis. When approved, Sandoz noted GP2015 may help expand treatment alternatives readily available to patients, healthcare providers and payers. … Read more

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Computerized Decision Support and the Quality of Care

Also available in PDF Summary The notion of quality of care in medicine is not new, but it is becoming increasingly important as the competitive health care market demands objective measures to compare physicians, hospitals, and managed care organizations. Informatics researchers and health care vendors have responded with computer systems that promise to improve health … Read more

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Enrollment still rising – and now, HMO count is, too

For all the talk of consolidation in the HMO industry, research suggests that the number of HMOs in the country is rising – not falling. The number of HMOs grew by 16 percent from 1995 to 1997 – the largest gain since the boom years of the 1980s. The rise corresponds with the sharpest gains … Read more

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Bad Tiered Formulary Designs Yield Poor Outcomes, High Cost

Martin Sipkoff Contributing Editor Now that tiered formularies rule the land, what many suspected is being demonstrated: Compliance is suffering and so, too, are patients. MANAGED CARE August 2004. ©MediMedia USA Now that tiered formularies rule the land, what many suspected is being demonstrated: Compliance is suffering and so, too, are patients. Martin Sipkoff Contributing Editor When … Read more

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When Should Insurers Cover Off-Label Drug Usage?

You don’t want to send money down a rat hole, but then again, off-label usage may be just what a patient needs The federal government’s expansion of coverage of off-label drug therapies is putting pressure on private insurers to follow suit, even as government and private payers clamor for physicians to avoid treatments where evidence … Read more

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Review Panels Pay Off For Colorado-Based Plan

The historically strong relationship between Rocky Mountain Health Plans and its doctors helps contain costs That one had to hurt. The June 1 issue of the New Yorker magazine contained an article called the “The Cost Conundrum: What a Texas Town Can Teach Us About Health Care.” Written by Atul Gawande, MD, a superstar of … Read more

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Biotech Med Ixekizumab (Taltz) Wins FDA Nod for Treatment of Plaque Psoriasis

Biotech Med Ixekizumab (Taltz) Wins FDA Nod for Treatment of Plaque Psoriasis Treatment will be available in second quarter of 2016   The FDA has approved ixekizumab (Taltz, Eli Lilly) injection 80 mg/mL for the treatment of moderate-to-severe plaque psoriasis in adult patients who are candidates for systemic therapy or phototherapy. Ixekizumab is designed to … Read more

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‘Have I Got a Magic Lamp for You!’

The current debate over a single payer system calls to mind the parable of the blind men describing an elephant. Michael S. Victoroff, MD “And Moses said to Pharaoh, ‘Let my people go!’ And Pharaoh said, ‘You don’t seem to understand the implications of a ‘single payer’ system.’” When I was little, there was a … Read more

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High Administrative Costs and Low Enrollment Led To the Demise of Startup Insurer Crystal Run

Download PDF Introduction Identifying the reasons for poor financial performance of health plans is important for startups and health plans expanding their markets and for state and federal regulators who aim to promote competitive markets, for health insurance. This is especially important during a time when 112 members of the House of Representatives have cosponsored … Read more

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AMA: Patients Will Feel Cuts in Medicare

Next year’s proposed 10 percent cut in Medicare payments is serving as a rallying point for members of the American Medical Association, which says the cuts will make it difficult for physicians to accept new Medicare patients. “The baby boomers begin entering the program in 2010, and the Medicare cuts increase the likelihood that there … Read more

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What Doctors Don’t Know About the New Plan Designs

Physicians are fairly ignorant of what consumer-directed health care will mean to them in terms of relations with patients and health plans Maureen Glabman Contributing Editor Melodie Blacklidge, MD, first heard the phrase in 1999. A savvy executive from Procter & Gamble called to ask the Cincinnati pediatrician if she could take her six-year-old in … Read more

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Health Care Reform Push Pits States Against Feds

A ‘health insurance czar’ might not make the final bill, if there is one, but the proposal evokes centuries-old tension Frank Diamond Managing Editor We’re gambling. The “health choices commissioner,” a k a the health insurance czar, might not be an issue when you read this. The legislative process that promises to bring us health … Read more

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FDA Approves Extended-Release Tofacitinib (Xeljanz XR) for Rheumatoid Arthritis

First once-daily oral JAK inhibitor treatment for RA indication The FDA has given the green light to extended-release tofacitinib citrate tablets (Xeljanz XR, Pfizer) for the once-daily treatment of moderate-to-severe rheumatoid arthritis (RA) in patients who have had an inadequate response to or are intolerant of methotrexate. Extended-release tofacitinib is the first and only once-daily … Read more

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A Little Careful Housekeeping Can Prevent a Lot of Headaches

This month we conclude our exploration of how you can use attorney-client privilege to protect certain confidential information and documents from scrutiny by the government or private litigants, particularly when conduct governed by federal or state fraud and abuse rules is at issue. When you discover possible reimbursement or fraud violations, or identify internal problems … Read more

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Is Research to Blame for High Cost of Cancer Drugs?

BIOLOGICS IN DEVELOPMENT Is Research to Blame for High Cost of Cancer Drugs? When it was attempting to take over AstraZeneca, Pfizer cited that company’s research and development capacity and its pipeline of new cancer drugs as primary reasons. Pfizer CEO Ian Read claims that governments around the world are pressuring drugmakers to produce products … Read more

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Can doing right business thing protect physicians liability

Operating a medical care firm includes all sorts of acute risks. Afterall, with other people’s own lives and wellbeing on both hands is really a critical issue. When most patients are thankful for its help and many days have become rewarding of a healthcare provider, medical care companies of all sizes has to think about … Read more

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No winks penn nudges nudges clinicians patients better decisions

Some academic researchers warn that managed care’s emphasis on low-cost care means that plans won’t support expensive research at academic medical centers. Industry representatives say research is not being ignored. Funding for clinical research is in jeopardy and managed care is at fault. That was the warning voiced by many health care leaders at a … Read more

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Ending Medicaid as We’ve Known It

CMS is granting waivers that impose work and other new requirements on some Medicaid beneficiaries. Medicaid managed care plans are wary of the added administrative complexity—and possibly a change in the Medicaid population’s risk profile. The Trump administration and CMS Administrator Seema Verma are on their way to giving the 53-year-old Medicaid program a major … Read more

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Health plan medical execs see pay increases

Compensation for medical directors and CMOs at staff-model health plans and in high-deductible health plans, as well as HMOs and PPOs, remains competitive when compared to what their counterparts at hospitals, physician practice groups, and in about 15 other categories get paid, according to Cejka Search. For all physician executives in general, the average compensation … Read more

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Medical devices works would tackle obesity new ways

Alere Inc. has initiated a voluntary withdrawal of the Alere INRatio and INRatio2 PT/INR anticoagulation monitoring systems from the U.S. market. The devices determine the international normalized ratio (INR) in samples of capillary whole blood. Alere is working with the FDA to determine the most appropriate timing for product discontinuation and will provide guidance on … Read more

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New Stark II Rules on Referrals Will Further Restrict Medical Practices

This month I want to share with you some late-breaking news about upcoming changes to the Stark law that affect all physicians and, indirectly, most other providers. The Omnibus Budget Reconciliation Act of 1989 (“Stark I”) disallowed physician referral of Medicare patients to clinical laboratories in which the physicians or members of their families had … Read more

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Has Medicare Gone Too Far To Control Imaging Costs?

It’s one thing to encourage efficiency on the technical side, but do you really want your radiologist to read 50% more scans or X-rays per hour? John Carroll Contributing Editor Just like every other payer in the country, Medicare has been looking for the best approach to reining in the high cost of imaging. And … Read more

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Orphan drugs account 19 sales in 2020

Drug candidate shows clinical activity in phase II studies The FDA’s Office of Orphan Products Development has granted orphan drug status to VAL-083 (DelMar Pharmaceuticals), a first-in-class small-molecule chemotherapeutic, for the treatment of women with ovarian cancer. VAL-083 previously received an orphan drug designation for glioma and medulloblastoma in the United States. In more than … Read more

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Specialty Pharmacy Management Will Become More Intense

Because specialty drug expenditures will grow, P&T committees may become more involved with drugs provided under the medical benefit Sarah Collins, MBA Specialty pharmaceuticals have contributed substantially to the rise in the nation’s drug bill over the last several years. Given their presence in the FDA pipeline, they are expected to continue to do so. … Read more

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P&T Digest: Pain Management

P&T Digest: Pain Management Randall P. Brewer, MD, Chief Medical Editor Chronic pain is a significant public health issue in the United States and an important concern for MCOs. Untreated or undertreated pain can evolve from a symptom to a chronic condition in its own right, one that has serious comorbid, economic, and quality-of-life consequences. … Read more

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Simple changes antibiotic treatment may help beat MRSA researchers find

Microbiologists have identified just how MRSA can be effectively treated by modernday antibiotics, even in the event conservative penicillin is likewise utilized. MRSA disease is from a form of Staphylococcal bacteria that is resistant to a number of the antibiotics used to deal with infections that are ordinary. This leads to significant morbidity and mortality … Read more

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March 2011

Features COVER STORY The Business Case for Process Improvement 3 Success Stories DIGITAL | HTML Can Arthroplasty’s Costs Be Contained? Try ‘bundled payments, accountability, and consumer involvement,’ one surgeon advises DIGITAL | HTML Stressed States Open Doors to Medicaid Managed Care Plans are increasingly trusted with management of the ABDs — aged, blind, and disabled DIGITAL | HTML US Family Health … Read more

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Computer-aided Multispectral Digital Analysis (MelaFind) for Assessing Atypical Skin Lesions

Many insurers have not yet updated their coverage policies since the FDA cleared this scanning tool in November 2011 A summary of ECRI Institute’s Emerging Technology Evidence Report Managed care leaders are striving to make evidence-based decisions about new and emerging health technology. Managed Care and ECRI Institute have joined in a collaboration to bring … Read more

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Plans Give Docs Seed Money for Meaningful-Use Systems

Highmark’s effort to get physicians up to speed with 21st century technology has been extended with a bonus system based on federal standards John Carroll When Don Fischer, MD, contemplates the future of health care, he sees an electronic health record in the hands of almost every physician in the country. And Fischer, the chief … Read more

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Proposal Would Limit Profit of Some California Plans

John Garamendi, California’s insurance commissioner, thinks some insurers have the potential to gouge the consumer, and wants to mandate a high medical loss ratio John Carroll John Garamendi has long been a thorn in the side of the managed care industry in California. The state insurance commissioner has not only wrested multimillion-dollar agreements for free … Read more

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Excluded in 2016: These Drugs Are On the Outside Looking In

Express Scripts and CVS have come out with their national formularies for 2016—and the list of drugs and other products (blood glucose test strips, for example) that didn’t make the cut and are newly excluded from the list of covered drugs. Uncovered Additions to the list of drugs excluded from the 2016 national formularies of … Read more

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States Increasingly Mandate Special Autism Services

Printer-friendly version Insurers are being handed some treatment responsibility for this complex disorder, but some say that it is an educational, not medical, task Advocacy organizations are making headway in state legislatures to expand mandated private health insurance coverage for autism services. In July, Louisiana and Pennsylvania passed legislation that guarantees specific services for children … Read more

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Could a Wal-Mart PBM Succeed?

The company can be expected to be as tough in the PBM arena as in retail, but it has a few hurdles to overcome John Carroll Contributing Editor When Wal-Mart tackles a new market, it has enough brawn to bend prices for every player in the game. The retail leviathan’s low-price generic drug program — … Read more

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Should Mental Health Patients Get Pharmacogenomic Testing?

Behavioral health companies are using cheek swabs to help choose the drugs that will work best for certain individuals. But psychiatrists say such testing still needs to prove itself. A new tool promises to make treatment of the mentally ill more cost-effective, but some experts wonder if it’s really ready for prime time. Pharmacogenomics — … Read more

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Breast Cancer Screening: Some Plans Do Better Than Others

Some of the nation’s best health plans are coming up with creative ways to encourage women to get mammograms. The importance of breast cancer screening received renewed attention in November after Elizabeth Edwards was diagnosed with the disease and acknowledged that she had not had a mammogram in four years. Edwards, the wife of last … Read more

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How Does Management of Echocardiography Affect Use Across Risk Groups?

UM for outpatient discretionary echocardiography appeared to reduce testing rates significantly ABSTRACT Purpose: This study evaluated the impact of an outpatient echocardiography utilization management (UM) program relative to a matched control (non-UM) group by measuring changes in utilization rates overall and within specific cardiac-risk subgroups. Methodology: Administrative claims data for enrollees from five states were … Read more

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Pharmacists test payment model based on outcomes

A new payment model at the School of Pharmacy and Health Professions at Creigton University demonstrates that high performance health care can be delivered by pharmacists — and they can get paid for it. In other words, a pay-for-performance (P4P) model was adopted, and compared with the traditional fee-for-service model. The P4P model could pay … Read more

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Confronting The Medicare Cost Shift

Plans are increasingly concerned about the degree to which providers overcharge them to make up for losses from government programs MargaretAnn Cross Contributing Editor When Blue Shield of California enters negotiations with providers each year, hospitals are pretty frank about why they need to raise prices, says David S. Joyner, senior vice president for network … Read more

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Health Plans Prepare to Meet Challenges of Climate Change

The overall effect on human health could be extensive and costly for payers, experts warn Martin Sipkoff Contributing Editor As the insurance entity responsible for the health of its members, health plans are actively involved in fighting the threats to public health posed by climate change. Several plans are making a commitment to reducing their … Read more

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Financial Penalties Reduce Hospital Readmissions, Yale Study Finds

Data support Obamacare’s Hospital Readmission Reduction Program Readmission rates declined after the announcement of the Hospital Readmission Reduction Program (HRRP), which penalizes hospitals for excess readmissions for acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumonia, according to a study from the Yale School of Medicine. The findings were published in the Journal of … Read more

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External Review of Disputes Gains Steam on Capitol Hill

Should consumers have the right to appeal, externally, coverage decisions made by their health plans? Many on Capitol Hill thought so last summer — but not enough to ensure passage of legislation mandating such procedures. Then a funny thing happened in November: The Democrats gained five seats in the House — and now Clinton supporters, … Read more

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May 1997

Will Health Plans Keep Their Erisa Shield? For more than two decades, a complex federal law has been interpreted to protect HMOs from malpractice liability claims. Now experts believe that protection could be in jeopardy. David L. Coleman, J.D. Master the ‘ABCs’ of Activity-Based Costing How do you find out whether a given capitation rate … Read more

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Physician Financial Incentives: Another UM Tool Bites the Dust

The managed care backlash has claimed another casualty: Financial incentives in physician contracts as a means of controlling utilization. Is capitation far behind? Has risk become another one of those “four-letter words”? Utilization-management incentives and global capitation seem to be in retreat. Public distaste for perceived managed care abuses, more government oversight, class-action lawsuits against … Read more

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Pharmacist Counseling Proves Cost-Efficient

Disease management programs that rely on phone calls to encourage medication adherence can be greatly enhanced by offering patient/pharmacist face-to-face counseling, says a study in Health Affairs. “An Integrated Pharmacy-Based Program Improved Medication Prescription and Adherence Rates in Diabetes Patients” concludes that “the in-person interaction between the retail pharmacist and patient was a contributing factor … Read more

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Will ‘Essential Benefits’ Break the Bank?

The size of the essential benefits package may determine whether insurers can operate in the highly regulated exchange market. Expect strong lobbying from health care interest groups. Michael D. Dalzell Senior Contributing Editor Quick: Which aspect of health care reform is likely to have the biggest impact? The individual mandate? The health insurance exchanges? No-cost … Read more

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Moving consumers head class

State lawmakers want hospitals to reveal what they’ve negotiated with health plans for lists of services that grow ever longer A few weeks ago the North Carolina legislature significantly upped the ante on what qualifies as price transparency in the health care industry. Lawmakers easily passed a bill that requires hospitals in the state to … Read more

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Health Insurers Often Foot Bill When Drug Coupons Are Used

Drugmakers and beneficiaries love coupons and patient-assistance programs, but they give PBMs and health plans a headache. Coupons are a way of life for bargain-seeking Americans. They use them to save on groceries, clothing, vacations—you name it. Some coupons are still clipped from newspapers and circulars in that old-timey way. Others are purely digital and … Read more

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Call for Manuscripts

Introduction Editorial Advisory Board Instructions for Authors Papers already published To supplement our coverage of the business of medicine, Managed Care publishes scientific peer-reviewed studies relating to the cost and effectiveness of programs, products, and procedures in health care financing and delivery. When Managed Care published its inaugural issue in 1992, we made a commitment to our readers to … Read more

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Nobody Wants M+C To Die, So Why Can’t We Make It Work?

John A. Marcille Remember the op-ed pieces back in 1997 when the Balanced Budget Act was passed? Many of them warned that such a worthy goal could not be achieved without pain. Then the economic boom really took hold, and we thought that the surplus could help us avoid making many of the tough choices. … Read more

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November 2012

Hospital at Home Saves 19% In Real-World Study The program is not for everyone, but patients who qualify appear to have superior outcomes and lower costs Jack McCain Hospital at Home: Compelling Findings, But Replicable in Other Systems? We invited experts from around the country to weigh in on the strengths and weaknesses of Hospital … Read more

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Liability insurance premium hikes take bite out of physicians’ income

No wonder increases in physician liability insurance premiums have caused such uproar over the last year. Data collected by the Medical Group Management Association show that physician income rose from 1999 to 2001. Liability insurance premiums skyrocketed, however, siphoning off an even greater portion of physician income. The result: nationwide protests, rallies, and lobbying efforts … Read more

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Meting out medication, not punishment

Focus medication-assisted treatment of opioid addiction on people who have been incarcerated. A program with a 12% success rate and (talk about perverse incentives!) the requirement that patients break the law to get treatment? That sounds like the kind of innovation payers should avoid, not embrace. But what if it also takes a small bite … Read more

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Our Own Humble Version Of Reading the Tea Leaves

There was a time when commentators confidently predicted that Bill Clinton’s presidency would stand or fall according to the fate of his administration’s ambitious program for reforming health care to guarantee all Americans coverage. That’s coverage, remember, and not mere access, as I recall Hillary Clinton stressing in a November 1993 speech that drew sharp … Read more

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Opioid Critics Take Aim at Pain Standards and Hospital Patient Surveys

New York advocacy group petitions CMS and Joint Commission More than 60 nonprofit groups and medical experts have sent a letter to the Joint Commission, a nonprofit agency that accredits U.S. hospitals, asking it to revisit its standards for pain management. Only hospitals that have been accredited can receive payments from government plans, such as … Read more

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Index of /archiveMC

Name Last modified Size Description Parent Directory 06-Jan-2001 16:01 – 0001/ 15-Mar-2000 21:06 – 0002/ 01-Jan-2001 14:05 – 0003/ 28-Apr-2000 09:13 – 0004/ 01-May-2000 23:41 – 0005/ 08-Jun-2000 12:01 – 0006/ 03-Jul-2000 22:10 – 0007/ 01-Aug-2000 18:24 – 0008/ 04-Sep-2000 22:03 – 0009/ 17-Nov-2000 10:25 – 0010/ 12-Nov-2000 00:36 – 0011/ 01-Jan-2001 12:52 – 0012/ … Read more

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Ethics of Alternative Medicine: The Unconventional Has Its Place

John La Puma, M.D. Two years ago, ethical issues in alternative medicine seemed hard to recognize. Alternative medicine was just starting to make medical headlines — the first academic centers and fellowships began, elective medical school classes surfaced, outpatient pharmacies stocked up on zinc and echinacea. So two years ago, I used Jonsen, Siegler and … Read more

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From Theory to Practice: Identifying Authentic Opinion Leaders to Improve Care

Also available in PDF ABSTRACT: Diffusion of Innovations and Opinion Leader theories can be translated into practical applications to improve health care delivery and financial performance by applying them to influence referral patterns and decrease variations in care. Health care organizations can rapidly spread “better practices” to their practicing physicians by understanding the social and communication … Read more

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Team-Care Approach Catching On

PRACTICE IMPROVEMENT In 2000, Gregg Omura, MD, saw 20 patients per day. Today, he sees about 30 patients daily, takes home substantially greater pay, and has more satisfied patients, along with a happier staff. “I also feel that I’m not working as hard,” adds Omura, whose family practice is part of Primary Care Partners, a … Read more

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Is It the Health Care Or Is It the System?

I think it started a couple of years ago when I’d heard for the hundredth time that the U.S. has the best health care in the world, just after reading about a study showing that we lagged some other developed nations in some significant area. I put the idea on my tickler list, and finally … Read more

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Federal Report: Theranos Blood-Testing Devices Often Failed Accuracy Requirements

The blood-testing devices that Theranos Inc. has touted as revolutionary often failed to meet the company’s own accuracy requirements for a range of tests, including one to help detect cancer, according to an article in the Wall Street Journal. The Journal got an early look at a federal report detailing deficiencies found by the Centers for Medicare and Medicaid … Read more

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Demystifying Pathways in Oncology

High costs mean a sea change in cancer management is urgently needed, and these tools can chart the way without eroding the physician’s role William J. Sullivan, MBA MANAGED CARE June 2012. ©MediMedia USA High costs mean a sea change in cancer management is urgently needed, and these tools can chart the way without eroding the physician’s … Read more

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Managed Care Backlash Seems To Run Out of Steam

Consumer reaction against managed care appears to be easing up, according to a recently released national survey that says that not only are patients willing to accept more restrictive health plans, but they understand why such measures are necessary. The California HealthCare Foundation says that in order to control rising costs, 54 percent of respondents … Read more

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Humana Readies New Online Assessment Tool

Turning to the Internet to help identify its high-risk members and monitor their care, Humana has embraced a Rhode Island company’s new personal-health assessment tool. Offered by QualityMetric Inc., the online service (www. amIhealthy.com) allows anyone with a personal computer to create a unique health profile that tells what the results mean, and what a … Read more

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The Show-me State Shows the Way On ‘Health Homes’ for Mental Health

The medical home model for delivering health care is getting tested for people with mental health problems. Missouri has been a pacesetter. Providers often get frustrated when called on to care for the mentally ill, says Joseph Parks, MD, of the National Council for Behavioral Health. “They’re more difficult to engage and to communicate with.” … Read more

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As Restrictions on Abortion Increase, Interest in Access Via Telemedicine Increases

As states continue to pass laws intended to restrict abortion, some groups see telemedicine as a way to provide access for the procedure. A recent study by a group led by Planned Parenthood and one conducted by Gynuity Health Projects, which provides research and technical assistance on reproductive health issues, found that medication abortions—two pills … Read more

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Headlines on Deadline …

Carolyn M. Clancy, MD, has been appointed director of the Agency for Healthcare Research and Quality. Clancy has served as acting director since the death of John M. Eisenberg, MD, in March 2002. Prior to that, she’d been director of AHRO’s Center for Outcomes and Effectiveness Research…. Kaiser Permanente plans to put all of its … Read more

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Physician, Tarnish Not Thine Image

PUBLIC RELATIONS Doctors who use the news media to criticize others, rather than initiate a constructive dialog about difficult issues, help erode the profession’s influence. Tim Olsen Criticizing your customers and your colleagues is a sound business practice that will help you position your industry in the best possible light. Sound like a wise public … Read more

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Aimmune’s peanut allergy drug meets main goal

Peanut allergy medication met the most important objective of a eagerly anticipated latestage analysis, sending its shares up 18 per cent premarket. The favorable trial information comes almost four weeks following French medication Programmer DBV Technologies SA’s stickon patch didn’t satisfactorily de-sensitize patients with all the allergies, however, the organization said it’d move on to … Read more

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Palliative Care Improves Quality of Life and Symptoms

Palliative care is a particular sort of health care. It is supposed to Two brand new NIH-funded studies contribute to growing evidence that palliative care may improve standard of living. Palliative care functions Together with other remedies to facilitate bodily Outward symptoms and give social and emotional aid to caregivers and patients. It is different … Read more

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Index of /archiveMC/9611

Name Last modified Size Description Parent Directory 04-Jan-98 21:46 – ../../archiveMC/9611/MC9611.compmon.gif 16-Mar-97 22:54 14k MC9611.compmon.shtml 16-Mar-97 22:54 2k MC9611.contents.shtml 16-Mar-97 22:54 3k MC9611.deselect.shtml 16-Mar-97 22:54 11k MC9611.editorsmemo.sh..16-Mar-97 22:54 3k MC9611.employer.shtml 16-Mar-97 22:54 8k MC9611.ethics.shtml 16-Mar-97 22:54 8k MC9611.legal.shtml 16-Mar-97 22:55 8k MC9611.liability.shtml 16-Mar-97 22:55 18k ../../archiveMC/9611/MC9611.news.gif 16-Mar-97 22:55 7k MC9611.news.shtml 16-Mar-97 22:55 8k MC9611.oregon.shtml 16-Mar-97 … Read more

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Managed Care’s West Coast Champion

 A CONVERSATION WITH WALTER A. ZELMAN, Ph.D. The head of the California Association of Health Plans began as an activist against the HMO industry, and gradually came to see the system as the best way to manage both care and costs. How did Walter Zelman, Ph.D., former executive director for California Common Cause and onetime … Read more

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Patrick Kennedy Sees More Talk Than Action in Mental Health Coverage and Parity

Insurers are playing ‘small ball’ and not showing leadership, says the former congressman. And some ‘spin-dry’ inpatient providers are doing more harm than good in combating the opioid epidemic. Meanwhile, Kennedy, who chronicled his own harrowing mental health and addiction struggles in a 2015 memoir, says he has been sober for more than six years. … Read more

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Competing HMOs Discover When It’s Better To Cooperate

Reducing paperwork, coordinating guidelines, and credentialing physicians are three areas being explored without damping the competitive spirit. Too much paperwork is a perennial physician complaint, the American Medical Association says. Doctors hate filling out forms. In Philadelphia, even a $225 incentive couldn’t entice more than 50 percent of physicians who saw pregnant women enrolled in … Read more

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Briefly Noted

The unfortunate distinction of being the state with the highest number of obese adults goes to Mississippi. According to a study by Trust for America’s Health and the Robert Wood Johnson Foundation, 35 percent of Mississippi’s adults are obese. “Obesity has contributed to a stunning rise in chronic disease rates and health care costs,” says … Read more

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High risk insurance pools might make comeback

If congressional Republicans Achieve death a Sweeping medical care bill, highrisk medical spas can make a come back. Highrisk pools are all government-run health programs Offering protection To folks who’ve high priced health conditions such as HIV, cancer or kidney disorder and also can not obtain insurance elsewhere. Washington established its high heeled pool, also … Read more

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November 1997

NCQA’s Quality Compass Points to Plan Differences The first comparative report of health plan performance produces surprising revelations — and a starting point for assessing a plan’s quality. But some people caution not to read too much into the numbers alone. Michael D. Dalzell The March of Capitation: Reversed or Just Delayed? Contrary to many … Read more

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Getting More for Our Health Care Dollar

The United States spends considerable money on health care. Unfortunately, the clinical return on investment has been coming up short for years, according to Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally, an oft-cited Commonwealth Fund study. Read moreabout Getting More for Our Health Care Dollar Meetings PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014 2014 Annual HEDIS® and … Read more

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Taming the Gene Genie

Genetic testing has taken off and may usher in a new era of genetically tailored health care. Insurers are figuring out how to cope with the avalanche of information. Could genetic counselors as standalone practitioners be part of the answer? Americans have fallen in love with the genetic test. They’re convinced their own personal genomes … Read more

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FDA to Act on Benlysta, Rare New Drug for Lupus

Increased understanding of the pathophysiology of lupus has resulted in a promising therapy for this complex disorder One of the most difficult-to-treat conditions is systemic lupus erythematosus (SLE), commonly called lupus by both professionals and laypeople. Because of this disease’s complexity, there hasn’t been a new drug approved for it for nearly 50 years. But … Read more

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Countdown Begins for Compliance With HIPAA Electronic Standards

Washington Watch If you thought a lot of time and money was spent on Y2K readiness, you ain’t seen nothin’ yet. Complying with the new rules for electronic transaction standards under the Health Insurance Portability and Accountability Act (HIPAA) is expected to exceed Y2K in terms of dollars and work hours. Some estimates peg the … Read more

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State Legislatures Move To Ban ‘Gag Rules’ Imposed on Physicians

Use of so-called “gag rules” by managed care plans is under attack in many states. Bills to ban these rules–which prevent physicians from discussing treatment options, payment policies and other plan provisions with patients–have been introduced in at least 24 states this year, says Anne Markus of George Washington University’s Intergovernmental Health Policy Project. Physician … Read more

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Is the Comeback Real — or Is It All Just an Illusion?

Financially, did health plans do better last year than in 1998 — or worse? The answer may depend on whom you talk with and the indicators you consider. The rating company A.M. Best says for the first nine months of 1999, profitability of 9 of the 15 largest publicly traded MCOs improved over the same … Read more

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New Governors in Georgia, California Push Reform, But Their Styles Contrast

Georgia Democratic Sen. Nadine Thomas has been trying to push managed care reform issues — such as giving patients the right to sue their HMOs — through the state legislature for years. But business and HMO industry influences have too often killed these bills, says Thomas, a registered nurse. This year was different. As the … Read more

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US judge invalidates allergan patents restasis

Bosom disease is the most widely recognized female malignant growth. Around the world, in excess of 1,000,000 ladies are analyzed each year. Anyway in spite of this increment, the death rate is declining. This is because of blend of elements including early finding and successful treatment. This composition which is introduced in two areas diagrams … Read more

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Providers lag in ICD-10 readiness

In an ideal world, payers and providers would be on the same page when it comes to ANSI X12, version 5010 compliance and ICD-10 code readiness. But a recent survey conducted by the Healthcare Information and Management Systems Society (HIMSS) indicates that most providers will not be ready to test their electronic health information systems … Read more

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